Clinical Review

Management of venous ulcer disease

BMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c6045 (Published 12 November 2010) Cite this as: BMJ 2010;341:c6045
  1. Wijnand Bert van Gent, vascular surgeon1,
  2. Esther Dorine Wilschut, resident, surgery1,
  3. Cees Wittens, vascular surgeon, professor of venous surgery 2
  1. 1Department of Vascular Surgery, Groene Hart Hospital, 2800 BB Gouda, Netherlands
  2. 2European Vascular Centre Aachen-Maastricht, Maastricht, Germany
  1. Correspondence to: WB van Gent wbvangent{at}yahoo.com

Summary points

  • Venous disease is the most common cause of leg ulcers

  • Signs of venous hypertension include lower extremity varicosities, oedema, venous dermatitis with hyperpigmentation, and lipodermatosclerosis

  • Compression is the mainstay of treatment, although surgery can help promote healing

  • Multi-component compression systems are more effective than single component ones

  • No specific wound dressing has been shown to be superior

  • Subfascial endoscopic perforator vein surgery reduces recurrence

A venous leg ulcer represents the severe end of the spectrum of chronic venous disease. Venous ulcers are the most common form of leg ulcer. Observational studies have reported the prevalence of venous leg ulcers to be 1-1.5%.1 2 A cross sectional study of a random sample of 1566 people aged 18-64 years from an urban Scottish population estimated the prevalence of venous leg ulcers to be around 1%.3 The estimated total treatment costs of venous leg ulcers are 1% of the total annual healthcare budget in western European countries.4 In the United States, treatment costs for venous ulcers in more than 6 million patients approach $2.5bn (£1.6bn; €1.8bn), and two million work days are lost annually because of venous ulcer disease.5 A recent prospective study performed in 23 specialised wound centres throughout Germany calculated the mean total cost of a venous ulcer per patient per year to be €9569 (€8658 (92%) direct costs and €911 (8%) indirect costs).6

Treatment is either conservative (bed rest, leg elevation, local treatment, and compression) or surgical (superficial and perforating vein ablation and deep vein reconstruction).

This review examines the prevention and treatment of venous leg ulcers and is based mostly on evidence from observational studies and some reviews and meta-analyses.

Sources and selection criteria

We searched PubMed and the Cochrane Library with the medical subject headings ”venous leg ulcers”, “venous leg ulcer”, “venous ulcers”, and “leg ulcers” combined …

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