Venous leg ulcers

Overview

General background | Focus of the review | Comments on evidence | Search and appraisal summary | Substantive changes at this update | Abstract | Cite as

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General background

Venous leg ulceration occurs secondary to venous reflux or obstruction. It affects up to 3 in 1000 people, and is more common in older people. Venous leg ulceration has a negative impact on quality of life and results in considerable costs to both patients and healthcare providers.

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Focus of the review

The aim of this overview is to update the research evidence for the management of venous leg ulceration. This update focuses on evidence for interventions that are likely to be available in current clinical practice. Dressings and larvae therapy are excluded from this overview because systematic reviews have not identified any robust evidence of benefit associated with dressings or larvae.

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Comments on evidence

Overviews of trials in venous ulceration have commented upon the general poor quality and short follow-up, which limit the generalisability of the research.

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Search and appraisal summary

The update literature search for this overview was carried out from the date of the last search, June 2011, to March 2014. For more information on the electronic databases searched and criteria applied during assessment of studies for potential relevance to the overview, please see the Methods section. Searching of electronic databases retrieved 116 studies. After deduplication and removal of conference abstracts, 63 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 43 studies and the further review of 20 full publications. Of the 20 full articles evaluated, four systematic reviews were updated and four RCTs were added at this update.

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Substantive changes at this update

Compression (bandages and stockings) versus no compression One systematic review updated[8] and one RCT added.[9] Categorisation unchanged (beneficial).

Compression stockings versus compression bandages One systematic review updated[8] and two RCTs added.[14][15] Categorisation unchanged (likely to be beneficial).

Pentoxifylline (oral) One systematic review updated.[26] Categorisation unchanged (beneficial).

Skin grafting One systematic review updated.[34] Categorisation unchanged (unknown effectiveness).

Compression (bandages and stockings) to prevent recurrence One systematic review updated[53] and one RCT added.[55] Categorisation unchanged (beneficial).

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 in 1000 people have active leg ulcers. Prevalence increases with age to about 20 in 1000 people aged over 80 years. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical questions: What are the effects of treatments for venous leg ulcers? What are the effects of 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 March 2014 (BMJ Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). RESULTS: At this update, searching of electronic databases retrieved 116 studies. After deduplication and removal of conference abstracts, 63 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 43 studies and the further review of 20 full publications. Of the 20 full articles evaluated, four systematic reviews were updated and four RCTs were added at this update. We performed a GRADE evaluation for 23 PICO combinations. CONCLUSIONS: In this systematic overview, we categorised the efficacy for 13 interventions based on information about the effectiveness and safety of advice to elevate leg, advice to keep leg active, compression stockings for prevention of recurrence, compression bandages and stockings to treat venous leg ulcers, laser treatment (low level), leg ulcer clinics, pentoxifylline, skin grafting, superficial vein surgery for prevention of recurrence, superficial vein surgery to treat venous leg ulcers, therapeutic ultrasound, and topical negative pressure.

Cite as

Nelson EA, Adderley U. Venous leg ulcers. Systematic review 1902. BMJ Clinical Evidence. . 2016 January. Accessed [date].

Latest citations

Sulodexide for treating venous leg ulcers. ( 19 August 2016 )

Oral aspirin for treating venous leg ulcers. ( 24 March 2016 )