Venous Leg Ulcers: Potential Algorithms of Care

Crystal V. James, Quinn Murray, So Youn Park, Nazanin Khajoueinejad, Jani Lee, Keval Ray, John Lantis

Research output: Contribution to journalReview articlepeer-review


Management of VLUs can be challenging, depending on wound complexity, and may require the use of several treatment modalities to achieve complete wound closure or significant wound area reduction. This review presents a systematic approach to management of VLUs based on previous literature and the authors’ clinical experience, with consideration given to wound size, etiology, and responses to prior treatment. Techniques described include debridement (autolytic, enzymatic, sharp/surgical), compression therapy, physical therapy, medical adjuncts, and cellular- and tissue-based therapy. The algorithm of care for VLUs is multimodal. Appropriate diagnostic studies must be performed, including venous duplex and appropriate pathophysiology to confirm the diagnosis of VLU. After the correct diagnosis is confirmed, appropriate treatment may commence. All patients should undergo appropriate wound debridement; the exact modality used is dependent on wound characteristics. Patients must also adhere to consistent compression therapy. Any underlying venous disease that is amenable to surgical intervention should be addressed. Treatment with a medical adjunct and physical therapy are recommended. For patients who do not achieve significant wound area reduction, the addition of CTP is recommended. Use of these methods should result in substantial wound area reduction and/or wound closure.

Original languageEnglish (US)
Pages (from-to)288-296
Number of pages9
Issue number12
StatePublished - Dec 2022
Externally publishedYes


  • cellular- and tissue-based therapy
  • fetal bovine dermis
  • negative pressure wound therapy
  • pentoxifylline
  • physical therapy
  • veins
  • venous leg ulcer

ASJC Scopus subject areas

  • General Medicine


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