Venous leg ulceration
Module created April 2017
Venous ulceration is the most common type of leg ulceration and it poses a significant clinical problem. A venous leg ulcer is an open skin lesion that usually occurs on the medial and lateral side of the lower leg between the ankle and the knee as a result of chronic venous insufficiency (CVI).
The prevalence of venous leg ulcers (VLUs) is increasing, coinciding with an ageing population. VLUs are a common recurring condition with an estimated prevalence of between 0.1% - 0.3% in the UK. 1% of the population will suffer from leg ulceration at some point in their lives doubling to 2% of people over 80 years of age. The impact of a venous leg ulcer poses significant challenges to both patients and the healthcare system. Patients report that a VLU can have a negative impact of all aspects of daily living and may cause depression, anxiety and social isolation. Leaking exudate, pain, odour, restricted mobility and sleep disturbance may be particularly distressing for the patient (Franks et al 2016).
Furthermore, VLUs cause an economic drain on the healthcare system. The Secure Anonymised Information Linkage Databank (https://saildatabank.com accessed 19th October 2020) contains information from 75% of General Practices within Wales. The leg ulcer data was examined over a 10-year period (2007 – 2017) and included general practitioner and district nurse visits along with information on the costs of treating the ulcers. The most expensive cost element was nurse visits £67.8 million, if escalated to the UK the costs rise to £1.98 million. Dressings and compression bandage costs in Wales was estimated to be £828 790. Overall the annual costs of treating leg ulcers in the UK are over £2 billion (Phillips et al 2020).With an estimated recurrence rate of around 26%-69% and an ever-aging population, all these figures may continue to rise (Franks et al 2016).
Venous leg ulcers are the most common type of lower limb wound (they account for around 50% of all ulcers) and are due to impaired function of the veins known as chronic venous insufficiency.
In view of an ever-increasing elderly population and demands on services, more patients are being cared for within the primary care setting. This guide is aimed to help general practitioners and practice nurses diagnose and manage venous leg ulcers with reference to best practice guidance. Much of this resource is based on the most recent European Wound Management Association (EWMA) statement guidelines, published in 2016, which highlight best current practice.