Venous ulceration

Venous ulceration is typically seen above the medial malleolus

Investigations

• ankle-brachial pressure index (ABPI) is important in non-healing ulcers to assess for poor arterial flow which could impair healing
• a 'normal' ABPI may be regarded as between 0.9 - 1.2. Values below 0.9 indicate arterial disease. Interestingly, values above 1.3 may also indicate arterial disease, in the form of false-negative results secondary to arterial calcification (e.g. In diabetics)

Management

• compression bandaging, usually four layer (only treatment shown to be of real benefit)
• oral pentoxifylline, a peripheral vasodilator, improves healing rate
• small evidence base supporting use of flavinoids (Daflon)
• little evidence to suggest benefit from hydrocolloid dressings, topical growth factors, ultrasound therapy and intermittent pneumatic compression