What are the treatments for a venous leg ulcer?
Consult your doctor if you think you have a leg ulcer, as it will require specialised treatment to help it heal.
The primary aim of treatment is ulcer healing. Secondary aims include reducing oedema and preventing recurrence(1).
Treatment of venous ulcers involves(2,1,3,4) :
- Compression: with compression bands or stockings until complete healing.
- Compression therapy is a mainstay of initial and long-term treatment for venous ulcers. Its aims are to reduce venous pressure, improve venous return, reduce oedema and pain, improve healing and prevent recurrence(1,5).
- Physical exercise: to improve calf muscle pump function, facilitate healing of the UVJ and improve ankle mobility and quality of life.
- Dressings: recommended to cover venous ulcers and promote wound healing in a moist environment.
- Wound treatment: Regular cleaning of the ulcer, maintaining a moist wound environment and controlling infection are essential. Removing damaged or dead parts of the wound to allow healthy tissue to develop is important.
- Lifestyle changes: Weight management, smoking cessation, physical activity and leg elevation where possible are recommended to aid healing and prevent recurrence.
- Medicinal treatments if necessary.
When these conservative approaches do not work, surgery may be required to treat underlying venous reflux, remove necrotic tissue or correct problems with superficial veins. These techniques can improve healing and reduce recurrence rates. Grafting is also possible(1,4).
Healing times vary from a few months to several years, and some wounds do not heal at all. With good wound care and compression therapy, venous leg ulcers generally heal within 6 months(6). The majority (up to 80%) of patients develop a recurrence within 3 months(3).
Prevention, effective treatment, reduction of healing time and prevention of recurrence are key issues in the management of venous leg ulcers(7).
Indeed, if venous leg ulcers (VLUs) are not properly managed, complications may arise(1,8):
- Reduced patient mobility and quality of life.
- Delayed healing and recurrence.
- Microbial superinfection: venous ulcers are susceptible to microbial invasion.
- Ankylosis of the ankle leading to joint stiffness.
- Although rare, chronic UVJ can undergo malignant changes and develop into skin cancer in the most serious cases.
- Bonkemeyer Millan S, Gan R, Townsend PE. Venous Ulcers: Diagnosis and Treatment. Am Fam Physician. 2019 Sep 1;100(5):298-305. PMID: 31478635.
- La compression médicale dans les affections veineuses chroniques, HAS, 2010
- Krizanova, O., Penesova, A., Hokynková, A., Pokorná, A., Samadian, A., & Babula, P. (2023). Chronic venous insufficiency and venous leg ulcers: Aetiology, on the pathophysiology-based treatment.. International wound journal. https://doi.org/10.1111/iwj.14405.
- Collège de dermatologie, Les référentiels des collèges, Elsevier-Masson, 8ème édition 2022
- Website, N. (2024, 15 octobre). Venous leg ulcer. nhs.uk. https://www.nhs.uk/conditions/leg-ulcer/
- Raffetto, J., Ligi, D., Maniscalco, R., Khalil, R., & Mannello, F. (2020). Why Venous Leg Ulcers Have Difficulty Healing: Overview on Pathophysiology, Clinical Consequences, and Treatment. Journal of Clinical Medicine, 10. https://doi.org/10.3390/jcm10010029.
- Ulcères veineux : nouveautés depuis les recommandations HAS 2010 | Portail Vasculaire de la SFMV. (s. d.). https://www.portailvasculaire.fr/ulceres-veineux-nouveautes-depuis-les-recommandations-has-2010
- Pugliese, D. (2016). Infection dans les ulcères veineux de jambe : considérations pour une gestion optimale chez les personnes âgées. Médicaments et vieillissement , 33, 87-96. https://doi.org/10.1007/s40266-016-0343-8.