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Section 5: Leg Ulcers Bandaging Selection CLICK HERE for printer friendly version of this page

Introduction

Leg ulceration is common and prevalence increases with age. Approximately 1% of the population will suffer from leg ulceration at some point in their lives. Venous ulceration is the most common type of leg ulceration followed by arterio-venous ulceration and arterial ulceration. Accurate, holistic assessment of the ulcer including ankle brachial pressure index (ABPI) is the key to successful treatment and must be performed prior to the application of any compression therapy.

Patients with the following features should be referred to the appropriate specialist at an early stage of management: see Section 15: Referral Pathways

Suspicion of malignancy	Diabetes mellitus
Peripheral arterial disease (ABPI<0.8)	Atypical distribution of ulcers
Rheumatoid/vasculitis	Non healing ulcer
Suspected contact dermatitis or dermatitis resistant to topical steroids

Type

Indicator/descriptor

Management aims

Treatment options

Venous

Medial gaiter area
Usually superficial with poorly defined edges
May have signs of venous disease on the leg i.e. haemosiderin staining, venous dermatitis, atrophie blanche, oedema, varicose veins, lipodermatoscleros i.e. ankle flare
ABPI >0.8

Reduce pressure in superficial veins
Aid venous return
Reduce oedema

Multi layer high compression bandaging (4 layer) should be routinely used for the treatment of venous leg ulcers

Short stretch inelastic compression bandages

Hosiery Kits

Elevation of limb and exercise are important

Arterio-Venous

Involves both arterial and venous insufficiency
May have signs of venous disease
ABPI between 0.6 - 0.8

Increase venous return (without compromising arterial perfusion
Reduce pain and oedema

Following specialist referral and under close supervision options may include:

Multi layer light compression bandaging (layers 1,2 and 4)

Short stretch inelastic compression bandages

Arterial

Any part of leg, commonly below ankle
Often over bony prominence
Localised oedema
Rest pain
Punched out appearance
Pale ulcer base
ABPI <0.6

Warm, insulate and protect limb
Support joints
Maintain surface temperature

Specialist referral for all patients.

Compression bandaging must NEVER be used on arterial leg ulcers.

Other considerations

Latex free brands of compression bandages should be used routinely.
Compression bandaging should only be applied by staff with appropriate training and in accordance with the manufacturer’s instructions.
Patients should be assessed for skin complications within 24-48 hours following initiation of compression.
Recurrence of venous ulcers can be substantially reduced by continuous application of compression hosiery.
Below knee graduated compression hosiery is recommended to prevent recurrence of venous leg ulcers. Patients should be offered the strongest compression which they can tolerate to prevent recurrence, with 2 pairs being supplied on a 6 monthly basis.
Nutrition: There is evidence to demonstrate that adequate levels of protein, fat, carbohydrates, vitamins and trace elements are necessary in wound healing, especially in collagen formation and maturation.
Pain control is an important factor in obtaining patient concordance to any treatment regime and a programme of pain management should be tailored to the needs of each individual patient.
Associated dermatitis which has not responded to topical steroid therapy should be referred for patch testing with a specific series for leg ulcers.

References:

SIGN Guideline 120: Management of Chronic Venous Leg Ulcers. August 2010 Click here
Best Practice Statement: Compression Hosiery Click here

Further Reading

1. SIGN Guideline 89: Diagnosis and Management of Peripheral Arterial Disease. October 2006 Click here
2. QIS Vascular Services: Care of the Patient with Vascular Diseases. October 2003 Click here

Updated 12 December 2016

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