Although there have been a number of previous guidelines for the treatment of VLUs, they have predominantly focused on wound care and compression. A previous systematic review of 14 VLU guidelines identified specific areas or knowledge gaps that needed to be addressed: role of advanced dressings; skin grafts, both autologous and human skin equivalents; role of physical therapy for improving ankle mobility to improve the calf-muscle pump; role of iliac obstruction and treatment with stenting; when and if to treat incompetent perforators; and prevention of progression from CEAP C4 to C6.
Furthermore, during the last several years, new forms of compression, advanced wound dressings, and minimally invasive techniques with lower morbidity have been developed. There has also been an increasing recognition of obstruction in the pathophysiology of VLUs, which requires a different treatment path.
Currently, the management of VLUs too often has been a siloed approach that focuses on the individual outcomes of ulcer healing and ulcer recurrence, with little integration of the two. What is important to the patient, however, is how quickly a VLU heals and how long it remains healed, which is best described in "ulcer-free days". Strategies for the prevention of the progression of chronic venous insufficiency from "pre-ulcer stages" CEAP C4 to C6 need to be adopted to avoid focusing on the disease state only when it has developed. This current guideline will attempt to critically evaluate, validate, and transfer such new techniques through evidence-based reviews. The overall structure of the current guidelines focuses on six major areas: