Combination of venous/arterial

• Refer to a vascular specialist if required
• Formulate a treatment plan following holistic assessment of the patient and their ulcer within the recommendation of the SIGN guidelines (14)

• Holistic assessment to identify the aetiology and amount of arterial and venous involvement, carried out by a Health Professional with a comprehensive and sound knowledge base of leg ulcer aetiology
• If ABPI greater than 0.8, apply a thin non-adherent dressing to the wound bed then, softban, softcrepe and a short stretch compression bandage. If the patient has dry surrounding skin, apply paraffin 50/50. All other bandages should be applied in a spiral with a 50% overlap. This dressing should be changed every 5 days or before, if strike-through occurs
• Soak legs in a bucket of tepid tap water
• If ABPI less than 0.8, no compression should be applied. Treat the ulcer depending on the wound bed and condition of surrounding skin. Referral to Specialist may be required

Compression should only be applied by a qualified nurse who has been supervised and deemed competent.

• As with previous ulcers
• If overweight, the patient should be advised about a reducing diet