Wounds on the leg
(One or more wounds above the malleolus)
Diagnosis and treatment
1. Assess and identify contributing causes for non-healing
2. Diagnose cause of non-healing and formulate treatment plan
Leg wounds with an adequate arterial supply and no aetiology other than venous insufficiency
- Refer for venous surgical/endovenous interventions.
- Strong compression therapy.
Leg wounds with signs of arterial disease
- Refer for vascular surgical/endovenous interventions and advice on compression.
- Pending vascular opinion, if no symptoms or arterial insufficiency, continue with mild graduated compression.
Leg wounds of other or uncertain aetiology
- Refer for dermatology opinion (or other specialist depending on symptoms and service arrangements).
- Pending specialist opinion if no symptoms of arterial insufficiency, continue with mild graduated compression.
Lymphoedema
- Refer for expert diagnosis and advice about lymphoedema.
Ongoing care and review
Review at each dressing change and weekly intervals
Monitor healing at 4-week intervals (or more frequently if concerned)
- If deteriorating or no significant progress towards healing, escalate.
If unhealed at 12 weeks, reassess
- If progressing to healing but still unhealed, undertake comprehensive re-assessment.
- If deteriorating or no significant progress towards healing, escalate.
Following healing
Venous Leg Ulceration
- Compression hosiery.
- 6-monthly review for replacement of compression garments and ongoing advice.
- If changes in lower limb symptoms or skin problems relating to hosiery, undertake comprehensive re-assessment.