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Treatment Options for Leg Ulcers




Burns   Fractures   Wound Bed Preparation


Leg Ulcers   Surgical Wounds   Tissue Viability
  Pressure Ulcers   Vascular Conditions   Infection & Inflammation
  Diabetic Foot   Lymphoedema   Moisture Imbalance
  I.V. and Catheter Sites   Soft Tissue Injuries   Edge of Wound


Scar Management


Minor Wounds    


Around 1% of the Australian population suffer from leg ulcers - they are more common in older people (over 65) and three times more likely to affect women than men.

The most common types of leg ulcers are:

  • Venous Leg Ulcers
  • Arterial Leg Ulcers
  • Mixed Aetiology Leg Ulcers

Venous Leg Ulcers
Venous leg ulcers comprise about 70% of all leg ulcers. A venous leg ulcer occurs secondary to underlying venous disease whereby damage to the superficial, deep or perforating veins leads to venous hypertension. The ulcer usually presents within the gaiter region of the leg and is superficial with irregular edges. The tissue within the ulcer is predominantly viable tissue. Exudate volumes tend to be moderate to high until the generalised oedema throughout the limb is controlled through sustained graduated compression therapy.


Venous Leg Ulcers


Arterial Leg Ucers
Arterial leg ulcers arise as a result of arterial disease whereby perfusion through the lower limb results in a cycle of tissue damage (ischaemia, hypoxia, necrosis) and the development of an ulcer. Arterial disease is either small vessel or large vessel in origin. Arterial leg ulcers are usually located from the malleolus (ankle) level down throughout the foot. They have a uniform edge and present as a cavity. The base tissue within the wound bed is often non viable or pale.

Unlike venous leg ulcers, compression therapy is NOT appropriate for treatment of arterial ulcers and referral is required to a vascular specialist. Where possible the aim will be to revascularise the limb. If surgical intervention is not appropriate, wound management products will be utilised.





Arterial Leg Ulcers


Mixed Aetiology Leg Ulcers
A mixed ulcer has its origin primarily in the chronic venous insufficiency in the patient's leg and its ability to heal is determined by the severity of the coexisting arterial insufficiency. It is possible to have both venous and arterial disease at the same time. Ulcers in the these patients can appear to be of either type, however accurate diagnosis remains vital as compression bandages are rarely suitable if there is significant arterial disease (ABPI<0.8). treatment of mixed ulcers usually focuses on managing the wound, using the approaches described above.>




Treatment Options


Venous Leg Ulcer

Compression to the lower limb is the single most important factor in the conservative treatment of venous leg ulcers. Graduated compression reduces the abnormally high pressures in the superficial veins and may improve the competence of the valves. The most desirable outcome is a healed ulcer that remains healed. Graduated compression has been shown to accelerate healing.

While compression is the most important component for venous leg ulcers, some ulcers produce very high amounts of exudate, especially during the first 1-2 weeks of treatment. For these cases Allevyn* Non-Adhesive can be used - a "state of the art" hydrocellular foam dressing which absorbs large amounts of exudate and also helps to create a moist wound environment. Where a high bacterial load needs to be addressed, Acticoat* 7 is the dressing of choice. Both these dressings are applied to the wound bed, under compression bandages.


Arterial Leg Ulcer
Following assessment by a vascular specialist these ulcers may require debridement of dead, necrotic tissue, in which case gel dressings such as IntraSite* Gel are suggested. Allevyn Non-Adhesive is particularly useful for arterial ulcers to protect and assist to maintain a moist wound environment.


Mixed Aetiology Leg Ulcer

Treatment is related to the prognosis and will be dictated by the venous/arterial component. Where the ulcer is more predominately venous, has a Doppler reading of between 0.6-0.8 and has been assessed by a specialist, a reduced compression system may be appropriate.




Product Selection



Type Product Selection


Venous Leg Ulcer


ABPI > 0.8


Multi-Layer Compression Bandaging:

Multi-Layer bandage systems are the recommended first-line therapy for treatment of venous leg ulcers (ILUAB). 1 Pressure is applied in layers providing an accummulation of compression.

Wound Dressings:


Exudate Management:

Absorb exudate and help to create a moist wound environment.


For management of bacterial load.



Arterial Ulcer


Compression Therapy is NOT SUITABLE for Treatment of Arterial Ulcers - Patients with suspected arterial ulcers should be referred to a vascular specialist.


Debriding Products:


Moisture Donating:

Rehydrate and break down dead, necrotic tissue.

Wound Management:


Exudate Management:

Protect the wound and help to maintain a moist wound environment.


Mixed Arterial and Venous Ulcer


ABPI = 0.5 to 0.8


Reduced Compression Therapy:




Related Links


European Wound Management Association - Understanding Compression Therapy Paper >


Global Wound Academy - >