Clinical Guidelines for a Chronic Leg Ulcer

Chronic leg ulcers are wounds or open sores that do not heal. Ulcers result from poor blood flow in the extremities and fall into three categories: venous ulcers, arterial (or ischemic) ulcers and diabetic ulcers. Accordingly, the clinical guidelines for treating chronic leg ulcers take these three types into consideration.

Diagnosis and Assessment

• According to the National Guideline Clearinghouse, a proper assessment of chronic leg ulcers is the key to effective treatment. Your doctor should review your medical history for conditions that suggest venous or arterial disease, perform a thorough physical examination of your legs while you are lying down and standing, determine your overall blood pressure and weight, perform urinalysis tests and assess the difference between blood pressure in your arms and ankles (a Doppler ankle brachial pressure index).

Venous Ulcers

• Treatment for venous ulcers centers on cleaning the wound, managing any infection and preventing further damage. The guidelines recommend cleaning the wound, usually by soaking the legs in water, choosing a dressing and antimicrobial ointment based on the severity of the wound and using compression therapy to help blood flow. Your doctor may also treat the ulcer with surgery, either to treat the underlying problem of venous hypertension, or to perform skin grafting in cases of serious ulcers.

Arterial Ulcers

• The clinical guidelines for leg ulcers recommend that doctors sort patients by their ankle brachial pressure index; guidelines state that patients whose index is at 0.8 or less require referral to a vascular surgeon to treat the underlying arterial disease and restore blood flow to the affected area. Experts at the Cleveland Clinic suggest that treatment for arterial ulcers varies, depending on the severity of disease, but generally involves cleaning the wound, eliminating or reducing anything that rubs against the ulcer, preventing additional ulcers and monitoring for infection.

Diabetic Ulcers

• Leg ulcer guidelines recommend that patients with diabetic ulcers see a specialist for treatment; the Cleveland Clinic's experts recommend avoiding pressure on diabetic ulcers and urging patients to stay off the affected leg until the wound heals. Surgical removal of the infected tissue and special shoes or orthotic inserts are also part of the treatment for diabetic ulcers.

Measurement and Management

• The clinical practice guidelines for leg ulcers recommend measuring leg ulcers at the time of diagnosis to monitor progress in healing and to more easily note wounds that do not respond to treatment. Measure the surface area of the wound by using a ruler and determining length times width. Your doctor should follow up with you weekly to chart healing progress; if complete healing has not occurred in 12 weeks, the guidelines recommend reassessing ankle brachial pressure to determine if the blood pressure in the affected area has worsened.