Healing for every body

Managing venous leg ulcers: A holistic therapeutic approach

Venous leg ulcers (VLUs) are the most common type of leg ulcer,1 often resulting from chronic venous insufficiency.2 They can impact patients’ quality of life and place a burden on healthcare systems. Effective diagnosis and treatment are key to improving outcomes. In this section, we explore how VLUs are diagnosed and managed, and how Essity’s product solutions can support each step of the treatment journey.

Diagnosis and prevention of complications

Timely diagnosis is essential to improve healing times and prevent complications.1 Initial and ongoing assessments should be holistic and include:3,4

Comprehensive patient medical history 

  • Comorbidities 
  • Medications 
  • Allergies 
  • Smoking, alcohol, and/or drug use 
  • Previous vascular procedures 
  • Lifestyle/psychosocial issues e.g. education, adherence to treatment plan, and capacity for self-care 

Clinical assessment 

  • Clinical signs of infection and inflammation 
  • Arterial assessment 
  • Edema assessment 
  • Signs of chronic venous insufficiency 
  • Wound assessment including exudate and odor 
  • Pain 
  • Quality of life

Venous leg ulcer classification using CEAP

Chronic venous disease (CVD) is classified using the international classification system CEAP (Clinical, Etiological, Anatomical, Pathological), ranging from C0 to C6, with increasing severity.⁵
C0 indicates no visible or palpable signs.
C1 includes spider veins or reticular veins, which may appear blue, red, purple, brown or darker depending on skin tone.⁶
C2 refers to varicose veins (≥3 mm), and C2r to recurrent varicose veins.
C3 involves edema.
C4 includes skin and subcutaneous tissue changes: C4a for pigmentation or eczema, C4b for lipodermatosclerosis or atrophie blanche, and C4c for corona phlebectatica.
C5 represents a healed venous ulcer, while C6 indicates an active ulcer, and C6r a recurrent active ulcer.⁵

Current guidelines recommend that all patients with VLUs receive a prompt holistic assessment, treatment of the underlying disease, appropriate wound and skin management and compression therapy.3,7

At the physician’s discretion and in collaboration with the patient, VLUs may be managed in a primary care or community-based setting. Some patients may require referral to additional members of a multidisciplinary team, including physicians, nurses, enterostomal therapy specialists, dietitians, physiotherapists, compression stocking specialists and infectious disease specialists.⁷

The importance of regular reassessment

Following diagnosis, patients should be reassessed on a 4-weekly basis.⁷ Regular follow-up enables ongoing assessment to determine whether symptoms are improving and if the current care plan is effective and remains appropriate.⁷ It is therefore important for the treating physician to build a sustainable relationship with the patient, identify their needs and agree on a treatment plan that suits the patient’s lifestyle.⁷

Red flag symptoms in venous leg ulcers

Immediate wound care intervention and/or onward referral is required when red flags symptoms are identified.⁸

Red flag symptoms include:⁸

  • Acute infection 
  • Symptoms of sepsis 
  • Acute or suspected chronic limb threatening ischemia 
  • Suspected acute deep vein thrombosis 
  • Suspected skin cancer 
  • Bleeding varicose veins

Wound care strategies for chronic venous ulcers

Observations 

  • Slough or necrotic tissue 

Treatment objectives

  • Remove non-viable tissue through debridement to support wound healing

Dressing/treatment options

Several debridement methods are available, including:

  • Selective sharp or surgical (e.g. scalpel, scissors, curette) 
  • Mechanical (e.g. debridement pad) 
  • Biological (larval therapy) 
  • Enzymatic 
  • Autolytic (not recommended for highly exuding wounds)

Suggested products 

Desired clinical outcome

  • Clean wound bed

Observations

  • Pain, redness, swelling, heat, odor, pus, exudate, friable granulation tissue

Treatment objectives

  • Reduce bacterial load to manage infection or inflammation

Dressing/treatment options

Local/systemic infection: consider topical antimicrobial or bacteria-binding dressings

  • For patients at high risk of wound infection, consider using a bacteria-binding dressing for early intervention

Suggested products 

  • Cutimed® Sorbact® - dressings with Sorbact® Technology irreversible bind bacteria to the DACC™-coated surface for an antibacterial effect without the release of active substances. This delivers safe and effective wound infection management and supports wound healing13

Desired clinical outcome 

  • Bacterial balance, reduced inflammation and wound progression

Observations 

  • Heavy exudate, risk of maceration/excoriation 
  • Dry to low exudate
  • Friable skin

Treatment objectives

  • Aim for a balanced and optimal moist wound healing environment
  • Choose a dressing to either absorb the excess exudate, or add moisture to dry wounds

Dressing/treatment options

  • High exudate – NPWT, superabsorber, hydrofibers, alginates or foams
  • Low exudate – hydrocolloids, hydrogels, films, moisture balancing dressing
  • If maceration/excoriation present, consider barrier preparation to protect fragile skin.

Suggested products 

  • Cutimed® Siltec® - gentle foam dressings for reliable exudate management, also under compression 
  • Cutimed® Sorbion® - range of superabsorbent dressings for effective exudate management for low to excessive exuding wounds even under compression14
  • Cutimed® Gel - hydrogel that donates moisture and maintains a moist wound environment as a result10

Desired clinical outcome 

  • Optimal moist wound healing environment

Observations 

  • Advancing, epithelialisation visible or non-advancing e.g. undermining, rolled edges
  • Stalled healing

Treatment objectives 

  • If wound shows signs of epithelialisation, continue with treatment. If not, re-assess wound
  • Support granulation and epithelisation

Dressing/treatment options 

  • Barrier preparations (e.g. barrier creams, ointments or films) wound contact layers to help prevent pain and trauma
  • Collagen (alginate) dressings

Suggested products 

  • Cuticell® Contact - a silicone wound contact layer that allows atraumatic dressing changes and promotes undisturbed wound healing16,17

Desired clinical outcome 

  • Advancing edge of wound, healthy peri-wound skin and signs of progression to wound closure
  • Complete epithelialization/wound closure

Note: If patient has leg ulceration, compression should be part of the treatment, where the ABPI allows.

Compression therapy for venous leg ulcers

Compression therapy is the corner stone of VLU treatment and should be used as early as possible as part of a holistic management program.3,4,7 Compression therapy to support venous function and address underlying venous insufficiency4 remains the first-line treatment in chronic VLU management as indicated in venous leg ulcer NICE Guidelines19, EMWA 2023 Guidelines3, JWC International Consensus Document 20244 and the 2016 S3-Guideline of the European Dermatology Forum20.

Compression has anti-inflammatory properties and reduces pain, exudate and associated skin problems.4 This contributes to shorter healing times and risk of recurrence.4 In addition to compression, it is essential to keep the VLU clean to prevent infection.4 Once the VLU has healed, a care plan should be put in place to prevent recurrence.7

Cutimed® and JOBST® offer a large spectrum of solutions for an integrated holistic approach

Cutimed‘s treatments offer a clinically evaluated easy-to-use option to support the management of chronic wounds, including VLUs, backed by available clinical evidence.

Products for venous leg ulcers include advanced wound care products such as Cutimed Sorbact, Cutimed Sorbion and Cutimed Siltec. These can be combined with compression therapy from JOBST, including JOBST UlcerCare compression system with a JOBST UlcerCare Liner, JOBST FarrowWrap, JOBST Compri2 and JOBST Compri2 Lite

Compression therapy using JOBST UlcerCare, JOBST FarrowWrap and JOBST Compri2 supports faster healing time and helps reduce the risk of further complications.7 Further information on compression products can be found at JOBST.com.au.

Disclaimer

This article is intended to be used as an information guide to be considered when the organization makes clinical decisions and does not constitute medical advice. For detailed device information, including indications for use, contraindications, effects, precautions, and warnings, please consult the product’s Instructions for Use (IFU) before use. In case of doubt please consult a healthcare professional.

References

  1. Körber A et al. Etiology of chronic leg ulcers in 31,619 patients in Germany analyzed by an expert survey. J Deutsche Derma Gesell. 2011;9(2):116-121.
  2. Young T. Back to basics: understanding venous leg ulceration. Wounds UK. 2017;13(2).
  3. Isoherranen K et al. Lower leg ulcer diagnosis & principles of treatment, including recommendations for comprehensive assessment and referral pathways. J Wound Management, 2023;24(2 Sup1):1-76.
  4. Nair HK et al. Leg ulceration in venous and arteriovenous insufficiency: assessment and management with compression therapy as part of a holistic wound‑healing strategy. J Wound Care. 2024;33(Sup10b):1-31.
  5. Lurie F et al. The 2020 update of the CEAP classification system and reporting standards. Journal of Vascular Surgery. 2020;8(3):342-352.
  6. Dhoonmoon L et al. International Consensus Document: Wound care and skin tone signs, symptoms and terminology for all skin tones. Wounds International. 2023.
  7. Fletcher J et al. Best practice statement: holistic management of venous leg ulceration (second edition). Wounds UK. 2022.
  8. Hyseni L et al. GID-HTE10048 Compression products for treating venous leg ulcers. NICE National Institute for Health and Care Excellence. 2024; accessed on November 11, 2025:
    https://www.nice.org.uk/guidance/hte32/documents/final-scope
  9. Edwards J, Stapley S. Debridement of diabetic foot ulcers. Cochrane Database Syst Rev. 2010(1):CD003556.
  10. Essity Group – commissioned in vitro study at S.M.T.L. test lab. UK: Fluid Affinity of Hydrogels. 2007.
  11. Stephen-Haynes J et al. Cutimed® Siltec foam and Cutimed® Sorbact® gel dressings: a clinical audit. Wounds UK. 2010;6(1):130-136.
  12. Ciprandi G et al. Meeting the challenges in pediatric wound care: Our 15-year experience with dialkylcarbamoyl chloride-coated dressing technology in acute and chronic wounds. Chronic Wound Care Manag Res. 2022;9:23-33.
  13. Kammerlander G et al. An investigation of Cutimed Sorbact as an antimicrobial alternative in wound management. Wounds UK. 2008;4(2):10-18.
  14. Essity Group. Commissioned laboratory testing at SMTL. Evaluation of absorbency and fluid retention of different superabsorbent wound dressings (based on EN 13726). Published online 2024.
  15. Heggemann J. Prospective observational study to examine clinical performance and safety of a gelling fiber dressing in routine clinical practice. Wounds Int. 2025; 16(2):38-44.
  16. Bateman SD. The vulnerable patient with high risk skin integrity - positive benefits of a long wear time, silicone wound contact layer. Wounds UK. 2015;11(1):82-7.
  17. Derbyshire A. Using a silicone-based dressing as a primary wound contact layer. Br J Nurs. 2014;23(Sup20):14-20.
  18. Oropallo A et al. Observational study of venous leg ulcer treated with a native collagen-alginate dressing and the impact on wound-related quality of life. Wound Manag Prev. 2024;70(4).
  19. NICE. Scenario: Venous leg ulcers | Management | Leg ulcer - venous | CKS | NICE. Accessed December 11, 2024.
    https://cks.nice.org.uk/topics/leg-ulcer-venous/management/venous-leg-ulcers
  20. Neumann HAM. Evidence‑based (S3) guidelines for diagnostics and treatment of venous leg ulcers. J Eur Acad Dermatol Venereol. 2016;30(11):1843-1875.

  21. BSN medical GmbH – commissioned in vitro study at Universitätsklinikum Jena, Klinik für Hautkrankheiten, Labor für In-vitro-Forschung und Routinediagnostik: Investigation of the cleansing effect of Cutimed® DebriClean, Debrisoft® and Cutisoft® Cotton. 2018 (40031810).

  22. BSN medical GmbH. In situ studies: Analysis of the cleansing effect of Cutimed® DebriClean against Hyperkeratosis and debris (40031949 & 40031814).

  23. BSN medical GmbH – commissioned in vitro studies at Universitätsklinikum Jena, Klinik für Hautkrankheiten, Labor für In-vitro-Forschung und Routinediagnostik: Evaluation of biofilm removal of Cutimed® DebriClean, Debrisoft® and Cutisoft® Cotton for bacteria. 2018 (40031811 & 40031908).