Venous Leg Ulcers (VLUs) are the most common type of leg ulcer,1 often resulting from chronic venous insufficiency.2 The prevalence of venous leg ulcers (VLUs) is up to 2% of the population worldwide, rising to 5% in adults aged ≥65 years old.1
Although VLUs can have a significant impact on quality of life and healthcare systems resources, they may be managed with effective diagnosis, classification and treatment.2 In this section, we explore how VLUs are diagnosed and managed, how to prevent further complications, and the different VLU classifications.
Diagnosis and prevention of complications
Timely diagnosis is essential to improve healing times and prevent complications.1 Initial and ongoing assessments should be holistic and include:3,4
Comprehensive patient medical history
- Comorbidities
- Medications
- Allergies
- Smoking, alcohol, and/or drug use
- Previous vascular procedures
- Lifestyle/psychosocial issues e.g. education, adherence to treatment plan, and capacity for self-care
Clinical assessment
- Clinical signs of infection and inflammation
- Arterial assessment
- Edema assessment
- Signs of chronic venous insufficiency
- Wound assessment including exudate and odor
- Pain
- Quality of life
The importance of regular reassessment
Following diagnosis, patients should be reassessed on a 4-weekly basis.7 Regular follow-up enables ongoing assessment to determine whether symptoms are improving and if the current care plan is effective and remains appropriate.7 It is therefore important for the treating physician to build a sustainable relationship with the patient, identify their needs and agree on a treatment plan that suits the patient’s lifestyle.7
Venous Leg Ulcer classification using CEAP
Chronic venous disease (CVD) is classified using the international classification system CEAP (Clinical, Etiological, Anatomical, Pathological), ranging from C0 to C6, with increasing severity.5
C0 indicates no visible or palpable signs.
C1 includes spider veins or reticular veins, which may appear blue, red, purple, brown or darker depending on skin tone.6
C2 refers to varicose veins (≥3 mm), and C2r to recurrent varicose veins.
C3 involves edema.
C4 includes skin and subcutaneous tissue changes: C4a for pigmentation or eczema, C4b for lipodermatosclerosis or atrophie blanche, and C4c for corona phlebectatica.
C5 represents a healed venous ulcer, while C6 indicates an active ulcer, and C6r a recurrent active ulcer.5
C0 indicates no visible or palpable signs.
C1 includes spider veins or reticular veins, which may appear blue, red, purple, brown or darker depending on skin tone.6
C2 refers to varicose veins (≥3 mm), and C2r to recurrent varicose veins.
C3 involves edema.
C4 includes skin and subcutaneous tissue changes: C4a for pigmentation or eczema, C4b for lipodermatosclerosis or atrophie blanche, and C4c for corona phlebectatica.
C5 represents a healed venous ulcer, while C6 indicates an active ulcer, and C6r a recurrent active ulcer.5
Figure title: CEAP grading of CVI. Chronic venous insufficiency occurs between C5 and C6[5]
Current guidelines recommend that all patients with VLUs receive a prompt holistic assessment, treatment of the underlying disease, appropriate wound and skin management and compression therapy.3,7
At the physician’s discretion and in collaboration with the patient, VLUs may be managed in a primary care or community-based setting. Some patients may require referral to additional members of a multidisciplinary team, including physicians, nurses, enterostomal therapy specialists, dietitians, physiotherapists, compression stocking specialists and infectious disease specialists.7
Hydrofera Blue®, Cutimed®, and JOBST® offer a comprehensive approach to efficient VLU healing
The Essity family of brands, Hydrofera Blue®, Cutimed®, and JOBST®, offer a full assortment of products to provide efficient VLU care. By using a 3-step comprehensive approach that combines our advanced wound care and compression therapy products, you can support the management of VLUs, backed by available clinical evidence.
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Step 1: Prepare the wound bed and control infection with Hydrofera Blue CLASSIC®
For VLUs, preparing the wound bed is essential at the beginning of treatment because it creates the conditions needed for the wound to heal and allows additional treatments, especially compression therapy, to be more effective. With Hydrofera Blue CLASSIC® antibacterial foam dressings, the result is a multifaceted, non-cytotoxic healing environment that reduces bioburden and aids in removing devitalized tissue from the wound bed.
Step 2: Manage the exudate with Cutimed® Sorbion®
VLUs often produce large amounts of drainage due to increased pressure in the leg veins. When excess exudate sits on the skin, it can cause maceration. Wound healing environments must not be too wet or too dry; finding optimal moisture balance is key. Cutimed® Sorbion® superabsorbent dressings feature outstanding absorption capacity, excellent exudate retention performance, and a cleansing effect to promote moist wound healing.
Step 3: Initiate compression therapy with JOBST® compression products
Compression therapy is the corner stone of VLU treatment and should be used as early as possible as part of a holistic management program.3,4,7 Compression has anti-inflammatory properties and reduces pain, exudate and associated skin problems.4 This contributes to shorter healing times and risk of recurrence.4 JOBST® offers a wide range of compression products, such as UlcerCare, Comprilan, Compri2, and FarrowWrap 4000, help support VLU care and complete the holistic, 3-step approach to efficient VLU treatment.
Disclaimer
This article is intended to be used as an information guide to be considered when the organization makes clinical decisions and does not constitute medical advice. For detailed device information, including indications for use, contraindications, effects, precautions, and warnings, please consult the product’s Instructions for Use (IFU) before use. In case of doubt please consult a healthcare professional.
References
- Körber A et al. Etiology of chronic leg ulcers in 31,619 patients in Germany analyzed by an expert survey. J Deutsche Derma Gesell. 2011;9(2):116-121.
- Young T. Back to basics: understanding venous leg ulceration. Wounds UK. 2017;13(2).
- Isoherranen K et al. Lower leg ulcer diagnosis & principles of treatment, including recommendations for comprehensive assessment and referral pathways. J Wound Management, 2023;24(2 Sup1):1-76.
- Nair HK et al. Leg ulceration in venous and arteriovenous insufficiency: assessment and management with compression therapy as part of a holistic wound‑healing strategy. J Wound Care. 2024;33(Sup10b):1-31.
- Lurie F et al. The 2020 update of the CEAP classification system and reporting standards. Journal of Vascular Surgery. 2020;8(3):342-352.
- Dhoonmoon L et al. International Consensus Document: Wound care and skin tone signs, symptoms and terminology for all skin tones. Wounds International. 2023.
- Fletcher J et al. Best practice statement: holistic management of venous leg ulceration (second edition). Wounds UK. 2022.