Intended for healthcare professionals

Practice Clinical updates

Diagnosis and management of venous leg ulcers

BMJ 2018; 362 doi: (Published 14 August 2018) Cite this as: BMJ 2018;362:k3115
  1. Chung Sim Lim, consultant vascular and endovascular surgeon1,
  2. Moushumi Baruah, general practitioner (partner)2,
  3. Sandeep S Bahia, consultant vascular and endovascular surgeon3
  1. 1Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London NW3 2QG, UK
  2. 2Burney Street Practice, Greenwich, London SE10 8EX, UK
  3. 3St George’s Vascular Institute, St George’s University Hospitals NHS Foundation Trust, London SW17 0QT, UK
  1. Correspondence to: C S Lim cslim{at}

What you need to know

  • Venous leg ulcers are the most severe manifestations of chronic venous disease caused by venous hypertension

  • The mainstay of treatment is compression bandaging, which promotes healing and reduces recurrence by improving venous and lymphatic return, microcirculation and inflammation

  • Offer early referral to vascular specialists for ulcers that have not healed within two weeks of treatment or that recur

  • Early endovenous ablation of superficial venous reflux promotes healing of venous leg ulcers

  • Compression hosiery, good skin care, and a vascular service assessment for surgery for superficial venous reflux help to reduce ulcer recurrence

Venous leg ulcers are the most common type of leg ulcer, with an estimated prevalence of 0.1 and 0.3% in the UK.1 The lifetime risk of developing a venous leg ulcer is 1%.23 A recent retrospective cohort study using THIN (The Health Improvement Network) data reported that in the UK 53% of all venous leg ulcers healed within 12 months, with a mean healing time of three months.4 Service provision in the UK for venous leg ulcers can be poor, with around half of patients receiving inadequate care, minimal specialist involvement, and lack of evidence-based treatment according to GP records.45 Similar significant evidence-practice gap has been reported around the world including in several developed countries.678 This clinical update, aimed at non-specialists, provides information on the diagnosis and management of venous leg ulcers, and offers multidisciplinary team support.

Sources and selection criteria

We searched PubMed using the terms “venous ulcer” and “compression therapy,” giving particular attention to meta-analyses and systematic reviews, including those from the Cochrane database, and guidelines from major international and national organisations and societies with an interest in venous ulcers. We also looked for publications in nursing journals to explore the up-to-date holistic approach in the diagnosis and management of venous …

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