title: What's new: Management of venous leg ulcers: Approach to venous leg ulcers.
abstract: Leg ulcerations are a common problem, with an estimated prevalence of 1% to 2% in the adult population. Venous leg ulcers are primarily treated in outpatient settings and often are managed by dermatologists. Recent advances in the diagnosis and treatment of leg ulcers combined with available evidence-based data will provide an update on this topic. A systematized approach and the judicious use of expensive advanced therapeutics are critical. Specialized arterial and venous studies are most commonly noninvasive. The ankle brachial pressure index can be performed with a handheld Doppler unit at the bedside by most clinicians. The vascular laboratory results and duplex Doppler findings are used to identify segmental defects and potential operative candidates. Studies of the venous system can also predict a subset of patients who may benefit from surgery. Successful leg ulcer management requires an interdisciplinary team to make the correct diagnosis, assess the vascular supply, and identify other modifiable factors to optimize healing. The aim of this continuing medical education article is to provide an update on the management of venous leg ulcers. Part I is focused on the approach to venous ulcer diagnostic testing.
authors.affiliation: Department of Medicine (Dermatology), University of Toronto, Toronto, Ontario, Canada. Electronic address: afsaneh.alavi@utoronto.ca.
authors.forename: Afsaneh
authors.initials: A
authors.lastname: Alavi
authors.affiliation: Department of Medicine (Dermatology), University of Toronto, Toronto, Ontario, Canada; Department of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: R Gary
authors.initials: RG
authors.lastname: Sibbald
authors.affiliation: Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Tania J
authors.initials: TJ
authors.lastname: Phillips
authors.affiliation: Department of Dermatology, Geisinger Health System, Danville, Pennsylvania.
authors.forename: O Fred
authors.initials: OF
authors.lastname: Miller
authors.affiliation: Department of Dermatology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: David J
authors.initials: DJ
authors.lastname: Margolis
authors.affiliation: Department of Surgery, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: William
authors.initials: W
authors.lastname: Marston
authors.affiliation: Faculty of Nursing, Queen's University, Kingston, Ontario, Canada.
authors.forename: Kevin
authors.initials: K
authors.lastname: Woo
authors.affiliation: Department of Dermatology, University of Pisa, Pisa, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Romanelli
authors.affiliation: Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, Florida.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Kirsner
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D002908:Chronic Disease; D003131:Combined Modality Therapy / Q000379:methods; D018450:Disease Progression; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D007871:Leg Ulcer / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010991:Plethysmography / Q000379:methods; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014481:United States / Q000453:epidemiology; D014647:Varicose Ulcer / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D014945:Wound Healing / Q000502:physiology*
keywords: leg ulcers; lipodermatosclerosis; venous disease; venous leg ulcers; wound healing