What to do when venous leg ulcers fail to heal
- If there is no improvement in wound healing/ulcer size in 4 weeks, revisit the assessment to ensure diagnosis of VLU is correct.
- Take a biopsy if other aetiology (autoimmune) or malignancy is suspected or if not healing after 4-6 weeks
- Is the surrounding skin of reasonable quality – has any varicose eczema been adequately treated?
- Is the treatment correct? If unsure, refer to specialist particularly if unsure of aetiology on presentation or non-healing atypical leg ulcers. It is important that the HCP is able to recognise when the management of an individual is beyond their competency and they make appropriate referral to a specialist service (eg, specialist VLU service, tissue viability, vascular, dermatology, diabetes service or cardiology).
EWMA Statement 5.4.b: Specialised leg ulcer clinics are recommended as the optimal service for treatment of VLU in the primary care setting
There are excellent examples of Practice Nurse led wound healing clinics in Cwmbran and Caerphilly and these services should be replicated in other areas to ensure successful assessment and management of venous leg ulcers, which include improved healing rates and reduction in the cost of treating venous leg ulceration (Young 2019)
The Lindsay Leg Club Foundation promotes and supports community based treatment, health promotion and education for people with leg ulcers. A directory of Leg Clubs including several within Wales can be found at https://www.legclub.org/leg-club-directory/search/United-Kingdom