Venous leg ulcers

Overview

Abstract | Cite as | Substantive changes

Abstract

INTRODUCTION: Leg ulcers usually occur secondary to venous reflux or obstruction, but 20% of people with leg ulcers have arterial disease, with or without venous disorders. Between 1.5 and 3.0/1000 people have active leg ulcers. Prevalence increases with age to about 20/1000 in people aged over 80 years. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of standard treatments, adjuvant treatments, and organisational interventions for venous leg ulcers? What are the effects of advice about self-help interventions in people receiving usual care for venous leg ulcers? What are the effects of interventions to prevent recurrence of venous leg ulcers? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 101 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: compression bandages and stockings, cultured allogenic (single or bilayer) skin replacement, debriding agents, dressings (cellulose, collagen, film, foam, hyaluronic acid-derived, semi-occlusive alginate), hydrocolloid (occlusive) dressings in the presence of compression, intermittent pneumatic compression, intravenous prostaglandin E1, larval therapy, laser treatment (low-level), leg ulcer clinics, multilayer elastic system, multilayer elastomeric (or non-elastomeric) high-compression regimens or bandages, oral treatments (aspirin, flavonoids, pentoxifylline, rutosides, stanozolol, sulodexide, thromboxane alpha2 antagonists, zinc), peri-ulcer injection of granulocyte-macrophage colony-stimulating factor, self-help (advice to elevate leg, to keep leg active, to modify diet, to stop smoking, to reduce weight), short-stretch bandages, single-layer non-elastic system, skin grafting, superficial vein surgery, systemic mesoglycan, therapeutic ultrasound, and topical treatments (antimicrobial agents, autologous platelet lysate, calcitonin gene-related peptide plus vasoactive intestinal polypeptide, freeze-dried keratinocyte lysate, mesoglycan, negative pressure, recombinant keratinocyte growth factor, platelet-derived growth factor).

Cite as

Nelson EA. Venous leg ulcers. Clinical Evidence 2011; 12:1902.

Top

Substantive changes

Compression bandages and stockings versus no compression One systematic review updated.[8] Categorisation unchanged (Beneficial).

Compression stockings versus compression bandages New evidence added.[8][12][13][14][15][16] Categorisation changed (from Beneficial to Likely to be beneficial).

Multilayer elastomeric high-compression regimens versus other layered regimens One systematic review updated.[8] New evidence added.[20] Categorisation unchanged (Beneficial).

Multilayer elastomeric high-compression bandages versus short-stretch bandages or Unna's boot One systematic review updated.[8] New evidence added.[22] Categorisation unchanged (Beneficial).

Debriding agents New evidence added.[33] Categorisation unchanged (Unknown effectiveness) as there remains insufficient evidence to assess the effects of debriding agents in people with venous leg ulcers.

Foam, film, hyaluronic acid-derived dressings, collagen, cellulose, or alginate (semi-occlusive) dressings New evidence added.[39][40] Categorisation unchanged (Unknown effectiveness) as there remains insufficient evidence to assess the effects of semi-occlusive dressings in people with venous leg ulcers.

Intermittent pneumatic compression One systematic review updated.[31] Categorisation unchanged (Unknown effectiveness) as there remains insufficient evidence to assess the effects of intermittent pneumatic compression in people with venous leg ulcers.

Antimicrobial agents (topical) New evidence added.[47][50] Categorisation unchanged (Unknown effectiveness) as there remains insufficient good-quality evidence to assess the effects of antimicrobial agents in people with venous leg ulcers.

Cultured allogenic bilayer skin replacement One systematic review updated.[65] New evidence added.[64] Categorisation unchanged (Likely to be beneficial).

Flavonoids (oral) New evidence added.[67] Categorisation unchanged (Likely to be beneficial).

Larval therapy New evidence added.[74][75] Categorisation unchanged (Unlikely to be beneficial).

Laser treatment (low-level) One systematic review updated, no new evidence added.[77] New evidence added.[82][83] Categorisation unchanged (Unknown effectiveness) as there remains insufficient good-quality evidence to assess the effects of low-level laser therapy in people with venous leg ulcers.

Skin grafting One systematic review updated.[65] Categorisation unchanged (Unknown effectiveness) as there remains insufficient evidence to assess the effects of skin grafting for people with venous leg ulcers.

Superficial vein surgery New evidence added.[94] Categorisation unchanged (Unknown effectiveness) as there remains insufficient good-quality evidence to assess the use of superficial vein surgery to treat venous leg ulcers.

Therapeutic ultrasound New evidence added.[101] Categorisation unchanged (Unknown effectiveness) as there remains insufficient evidence to assess the effects of ultrasound in people with venous leg ulcers.

Leg ulcer clinics New evidence added.[106] Categorisation unchanged (Unknown effectiveness) as there remains insufficient good-quality evidence to assess leg ulcer clinics for people with venous leg ulcers.

Latest citations

Oral zinc for arterial and venous leg ulcers. ( 12 November 2014 )

Compression for preventing recurrence of venous ulcers. ( 12 November 2014 )