Venous leg ulcers: modern evaluation and management.

BACKGROUND: Venous leg ulcers are common in the adult population and cause a significant social economic burden. Despite their prevalence, venous leg ulcers are often managed inadequately.

OBJECTIVE: To provide an overview of venous ulceration, including a review of the current understanding of the pathophysiology of venous ulceration and the implications for management of venous ulceration.

METHODS: A review of the literature.

RESULTS: Modern methods of investigation have led to an improvement in our understanding of the pathophysiology of venous disease. In many patients, superficial and/or perforator venous disease is the only underlying hemodynamic abnormality. Although compression should serve as the cornerstone of treatment of venous ulceration, surgery and/or sclerotherapy can treat incompetent superficial and perforator veins. Important hemodynamic improvement is obtained, and the long-term prognosis of these patients is greatly improved.

CONCLUSION: One must define the basic underlying abnormality of the venous system to form a rational, individualized management plan for the patient with venous ulceration.