Leg ulcer: What is new and what is effective?

In the revised guideline on venous leg ulcers there are several changes to the 2005 version. The guideline committee advices to use not only the C from the CEAP score, but also the VCSS and a quality of life (QoL) score in the assessment of the clinical picture. These can provide insight into the burden of disease and the effects of treatment as experienced by the patient. A duplex ultrasound should be performed in every patient to establish the underlying etiology and to evaluate if of therapeutic intervention is possible. The guideline committee also recommends an ankle-brachial index in every patient with a leg ulcer. Firstly in treating venous leg ulcers surgical debridement is important. Secondly treatment of superficial venous insufficiency should be considered in every patient to prevent recurrence. Negative pressure therapy or skingrafts should be considered, especially in non-healing ulcers. Lastly, there is insufficient scientific evidence for the use of manual lymph drainage or intensive training programs focused on improvement of the calf muscle pumpfunction, leg elevation, healthy diet or compliance to (compression) therapy. Compression therapy remains the cornerstone in the treatment of venous ulcer, but is discussed in a separate guideline.