What are the key components of a comprehensive management plan for venous ulcers?

A comprehensive management plan for venous ulcers should include the following key components:

• Accurate diagnosis and assessment: Use clinical evaluation and duplex ultrasound to confirm venous insufficiency and assess the extent of venous reflux, which guides treatment planning NICE CG168. Document ulcer size, depth, and characteristics to monitor healing progress Kelechi et al. 2012.
• Compression therapy: This is the cornerstone of venous ulcer management. Multi-layer compression bandaging or compression hosiery should be applied to improve venous return and reduce oedema, unless contraindicated by arterial disease NICE CG168. Compression should be tailored to the patient’s tolerance and ulcer severity Kelechi et al. 2012.
• Wound care and dressings: Maintain a moist wound environment using appropriate dressings to promote healing and protect from infection. Dressing choice should consider wound exudate, infection status, and patient preference Kelechi et al. 2012.
• Infection control: Monitor for signs of infection and treat promptly with appropriate antibiotics if infection is confirmed or strongly suspected NICE CG168.
• Debridement: Regular debridement of necrotic tissue by trained healthcare professionals is essential to promote healing and reduce bacterial load Kelechi et al. 2012.
• Address underlying venous pathology: Referral to a vascular service for assessment and possible interventional treatment such as endothermal ablation, foam sclerotherapy, or surgery should be considered to correct venous reflux and prevent ulcer recurrence NICE CG168.
• Patient education and lifestyle advice: Provide information on the nature of venous disease, importance of adherence to compression therapy, leg elevation, weight management, and physical activity to improve venous return and prevent recurrence NICE CG168.
• Multidisciplinary approach: Involve specialist nurses, vascular surgeons, and other relevant professionals to optimize wound care, manage comorbidities, and support patient adherence Kelechi et al. 2012.

This integrated approach aligns with NICE guidance on varicose veins and venous ulcers NICE CG168 and is supported by evidence-based wound management principles from recent literature emphasizing the importance of compression, wound care, and addressing venous insufficiency Kelechi et al. 2012. Emerging literature also highlights the need to consider mixed arterial-venous disease in some patients, which may require modification of compression strategies Alagha et al. 2024.