Venous leg ulcers (VLUs), the most common type of lower extremity wounds, afflict approximately 1% of the western population during their lifetime and represent a significant burden for patients and healthcare systems¹. In the United States alone, the annual cost to treat VLUs is estimated to be $14.9 billion². Fifty-five percent of healed VLUs reoccur within the first 12 months of closure³ and 28% of patients experience more than 10 episodes of VLUs in their lifetime². Compression therapy, essential for the management of VLUs, has been shown to improve venous leg ulcer healing rates as compared to VLUs where compression therapy is not used⁴. Compression therapy also reduces the risk of VLU reoccurrence⁵. Although clinical guidelines recognize compression as the most effective VLU treatment, it is significantly underutilized, resulting in missed opportunities to heal wounds, improve patient quality of life, and maximize health care efficiency⁶.

In December of 2014, a group of international experts in leg ulcers and venous disease developed and published “Consensus Recommendations: Simplifying Venous Leg Ulcer Management” to encourage broader use of compression therapy by simplifying key management principles⁷. An ‘ABC’ model of care is presented to simplify treatment with emphasis on the active treatment phase. This document provides practical guidance to clarify best practice in assessment and management of leg ulcers around three main steps: Assessment and Diagnosis Best practice wound and skin management, and Compression therapy for active treatment and for prevention of recurrence. The ‘ABC’ model is a simplified approach that helps clinicians understand why, when, and how compression therapy should be used⁶.

Assessment and Diagnosis focuses on the importance of determining wound etiology and indicators for appropriate management. Tables and tools provided in this section include a VLU assessment pathway, examples of common lower leg tissue changes associated with venous insufficiency, interpretation of vascular testing, healing time expectations, and a newly established VLU categorization tool. Categorization is helpful to determine prognosis and to establish appropriate time frames for monitoring, reassessment, and the need for specialty referrals.

Best practice wound and skin management highlights considerations for structured skin care and wound management protocols including skin care, debridement, periwound skin management, and wound dressings. Appropriate wound dressings are used to protect the wound and manage exudate levels. However, the most important factor cited to reduce exudate levels is appropriate and sustained compression therapy.

Compression therapy for leg ulcer management focuses on implementation of compression therapy. The expert working group supports the use of multicomponent compression therapy systems as they generally have high stiffness. Research suggests that achieving high pressure over the calf muscle alone, compared to reducing graduated pressure from ankle to the calf, may be a more effective way of improving venous return⁸. This section is rich with tools and tables to guide clinicians in selecting appropriate compression bandaging systems.

This document ends with tips for optimizing compression therapy to ensure success with the ABC model and to promote patient concordance. Methods for patient, caregiver and family education are highlighted, as patient and family education cannot be overlooked.

To download the VLU Consensus Document, go to https://engage.3M.com/vlu

Regards,

Lynn Peterson BSN, RN, CWOCN, CLWT

Technical Service Specialist
3M Medical Markets Center, 3M Medical Solutions Division