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Launch of the new BPS: Addressing Complexities in the Management of Venous Leg Ulcers


I sometimes wonder whether we are making any headway on improving the healing rates of patients with venous leg ulcers. Every day, most referrals that come into my service are associated with venous leg ulcers (VLUs) and many of the patients will have had their ulcer for several months. We have a venous leg ulcer pathway in place so why aren’t these patients healing in the expected timescale?

“In a nutshell, its because they are complex and if the complex idiosyncrasies responsible for delayed healing aren’t recognised, many of these wounds will continue to be a problem.”

Historically, complexity in wound care has tended to focus on the wound itself, however the factors that contribute to this status are multifaceted and include the patient, healthcare professionals and resource/ treatment related factors. Leg ulcers can be complex to manage and for those struggling with a patient’s leg ulcer these wider factors can go unrecognised, so a shift is needed to ensure they are routinely considered as part of a holistic assessment. Once identified, we need to understand the relevance of these in terms of healing potential and take the appropriate course of action to manage the risk.

The development of a Best Practice Statement (BPS) on addressing complexities in the management of VLUs is long overdue and will be a valuable resource for both experienced generalist and specialist clinicians working in wound care.

“This document refreshingly challenges the ‘status quo’ of some leg ulcer care through its use of myths and truths and importantly promotes early compression therapy and early endovenous intervention as a means of improving healing rates and ulcer recurrence.”

Contained within the document is useful guidance on the issues we face every day around complex leg ulcers such as ‘wet legs’ and ‘red legs’. The document also has a whole section on patient related complexities such as managing patients with a high BMI or large limbs, abnormal shaped limbs or those lacking mental capacity.

“Many of our patients will also have underlying conditions that may contribute to the complexity of their VLU and this BPS sets out some of the more common conditions offering clear, evidence-based guidance on managing these cases.”

I believe that this document may challenge the ‘familiar’ or ritualistic practice of some clinicians who possibly due to a lack of knowledge, put patients onto a ‘one size fits all’ treatment pathway. This, we know will not be effective due to the diversity of our patients in terms of complexity. Using this BPS as a reference point will raise awareness of complexity and hopefully will lead to better outcomes for our patients.

Maybe my referral rates will then start to reduce!


Sarah Gardner – Clinical lead, Tissue viability, Oxford Health NHS FT(RN, DN Cert, CPT, BA Hons, MSc, QN.)

Follow Sarah on Twitter for further updates: @woundwitch63



If you would like to download your copy of the Best Practice Statement: Addressing Complexities in the Management of Venous Leg Ulcers click here

Alternatively if you would like a hard copy of the document click here and your local rep will be in touch.


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