section name header

Information

Effective treatment of a vascular ulcer involves caring for the wound as well as managing the underlying vascular disease. The goals and treatment recommendations vary depending on the type of ulcer.

Type of ulcerTreatment goalsTherapies and proceduresWound care
Venous
  • Control edema
  • Manage underlying venous disease
  • Provide appropriate wound care
  • Limb elevation to allow gravity to drain fluid from the limb
  • Compression bandages, layered compression bandages, elastic bandages, compression pumps, compression stockings, or graduated compression support hosiery to reduce edema
  • Bandaging and wrapping (paste wrap such as Unna's boot) may be used to provide compression, protection, and a moist environment for healing
  • Apply dressings to promote moist wound healing, growth of granulation tissue, and reepithelialization.
  • Apply growth factors to the wound bed, as ordered, to improve healing rate.
  • Consider advanced wound healing technologies such as cellular tissue products (CTPS) for a venous ulcer that fails to heal within 4 weeks of treatment.
Arterial
  • Reestablish arterial flow
  • Provide appropriate wound care and wound protection
  • Arterial bypass to restore arterial flow
  • Angioplasty (with possible stent insertion) to treat arterial stenosis
  • Keep the wound dry and protected from pressure or trauma.
  • As ordered, apply an antiseptic or antimicrobial agent and then place small gauze pads between the toes. Change the pads daily to keep toe ulcers dry.
  • Never soak arterial ulcers.
  • If revascularization succeeds, change the type of dressing to keep moist tissue moist and dry tissue dry.
Lymphatic
  • Reduce edema
  • Prevent infection
  • Provide appropriate wound care
  • Limb elevation and compression pump therapy to reduce edema
  • Comprehensive decongestive therapy (a form of massage) to reduce edema and improve circulation
  • Follow guidelines for venous ulcer care.
  • Choose dressings that can manage large fluid loads while protecting the surrounding skin, such as foams and other absorbent dressings.
  • Negative pressure wound therapy may be a good alternative to dressings for copious fluid leakage.

Take note

Documenting compression bandage application

Best dressed

Dressings for vascular ulcers
DressingIndications and contraindications
Venous ulcersArterial ulcersLymphatic ulcers
Alginate/hydrofiber
  • Use to manage copious drainage.
  • Use to manage copious drainage.
  • Use to manage copious drainage.
Foam
  • Use to protect the ulcer.
  • Use for absorption underneath a compression dressing.
  • Use to protect the ulcer.
  • Use with dry gangrene.
  • Use for a moist, revascularized ulcer.
  • Use to protect the ulcer.
  • Use to absorb drainage.
Hydrocolloid
  • Use to promote granulation.
  • Use to manage pain.
  • Don't use when copious drainage is present.
  • Use for autolytic debridement.
  • Use for primary dressing after revascularization.
  • Don't use on ischemic tissue.
  • Don't use when infection or cellulitis is present.
  • Use to protect the skin.
  • Use to promote epithelialization.
  • Don't use when copious drainage is present.
  • Don't use when cellulitis is present.
Hydrogel
  • Don't use when copious drainage is present.
  • Use to maintain a moist wound bed.
  • Use for autolytic debridement.
  • Use to manage pain.
  • Use for autolytic debridement.
Transparent film
  • Use isn't indicated.
  • Use only after the ulcer has almost completely healed.
  • Use to protect fragile skin.