How should I assess the adequacy of venous return in a patient with a chronic leg ulcer?

Assessing the adequacy of venous return in a patient with a chronic leg ulcer involves clinical examination and diagnostic imaging.

First, perform a thorough clinical assessment including inspection for signs of venous insufficiency such as skin changes (pigmentation, eczema), presence of varicose veins, and ulcer characteristics below the knee. Palpate for pitting oedema and assess for collateral superficial veins, which may indicate venous incompetence. Document symptoms like pain, heaviness, or swelling that suggest venous disease.

Second, use duplex ultrasound scanning to confirm the diagnosis of venous reflux and to evaluate the extent of venous incompetence and obstruction. Duplex ultrasound is the standard method to assess venous anatomy and function, including the presence of truncal reflux or deep venous thrombosis, which can impair venous return.

Referral to a vascular service is recommended for patients with venous leg ulcers to enable comprehensive duplex ultrasound assessment and to plan appropriate management.