What's new: Management of venous leg ulcers : Approach to venous leg ulcers - 18/04/17

Doi : 10.1016/j.jaad.2014.10.048

Afsaneh Alavi, MD ^a,^⁎ , R. Gary Sibbald, MD ^a,^b, Tania J. Phillips, MD ^c, O. Fred Miller, MD ^d, David J. Margolis, MD, PhD ^e, William Marston, MD ^f, Kevin Woo, RN, PhD ^g, Marco Romanelli, MD, PhD ^h, Robert S. Kirsner, MD, PhD ⁱ
^a Department of Medicine (Dermatology), University of Toronto, Toronto, Ontario, Canada
^b Department of Public Health, University of Toronto, Toronto, Ontario, Canada
^c Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
^d Department of Dermatology, Geisinger Health System, Danville, Pennsylvania
^e Department of Dermatology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
^f Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
^g Faculty of Nursing, Queen's University, Kingston, Ontario, Canada
^h Department of Dermatology, University of Pisa, Pisa, Italy
ⁱ Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, Florida

^∗Correspondence to: Afsaneh Alavi, MD, Wound Care Centre, Women's College Hospital (Main Bldg), 76 Grenville St, 5th Fl, Toronto, ON M5S 1B2, Canada.Wound Care CentreWomen's College Hospital (Main Bldg)76 Grenville St, 5th FlTorontoON M5S 1B2Canada

Abstract

Leg ulcerations are a common problem, with an estimated prevalence of 1% to 2% in the adult population. Venous leg ulcers are primarily treated in outpatient settings and often are managed by dermatologists. Recent advances in the diagnosis and treatment of leg ulcers combined with available evidence-based data will provide an update on this topic. A systematized approach and the judicious use of expensive advanced therapeutics are critical. Specialized arterial and venous studies are most commonly noninvasive. The ankle brachial pressure index can be performed with a handheld Doppler unit at the bedside by most clinicians. The vascular laboratory results and duplex Doppler findings are used to identify segmental defects and potential operative candidates. Studies of the venous system can also predict a subset of patients who may benefit from surgery. Successful leg ulcer management requires an interdisciplinary team to make the correct diagnosis, assess the vascular supply, and identify other modifiable factors to optimize healing. The aim of this continuing medical education article is to provide an update on the management of venous leg ulcers. Part I is focused on the approach to venous ulcer diagnostic testing.

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Key words : leg ulcers, lipodermatosclerosis, venous disease, venous leg ulcers, wound healing

Abbreviations used : ABPI, CEAP, DVT, LDS, TcPCO₂, TcPO₂, VLU

Plan

Introduction

Epidemiology

Pathophysiology of venous disease/venous ulcers

Pathogenesis of venous disease

Pathogenesis of nonhealing wounds

Cost

Spectrum of disease

Differential diagnoses of venous disease/venous leg ulcers

Approach to venous leg ulcers

Assessment of factors that delay healing

Wound assessment

Wound biopsy

Vascular assessment: Arterial and venous

Investigation of the arterial system

Microcirculation/transcutaneous oxygen

Macrocirculation

Investigation of the venous system

	Funding sources: None.
	Dr Kirsner is an advisory board member of 3M, KCI, Keraplast, Kerecis, and Mölnlycke, and is an investigator for Macrocure and Smith & Nephew. Dr Margolis is an advisory board member of Kerecis. Dr Alavi is an advisory board member for AbbVie, Janssen; an investigator for AbbVie, Novartis, and Xoma; and received a grant from AbbVie. The other authors have no conflicts of interest to declare.
	Date of release: April 2016
	Expiration date: April 2019