This Consensus Statement was developed with the objective of creating a concise document that incorporates new clinical and research findings, and that Health Care Providers can use in the clinic. Nineteen Health Care Providers from across Canada were involved in the process. Their backgrounds included physicians, nurses, Nurses Specializing in Wound Ostomy and Continence (NSWOCs) and therapists.
An initial draft document was reviewed by the panel on multiple occasions for feedback, modification and determination of the level of consensus. The Consensus Statement was divided into 23 sections and the panel achieved full consensus on 20 sections and greater than 85% consensus on the remaining 3 sections. This was developed independent of input from any wound care companies.
The Consensus Statement reiterates the foundational principles of managing venous leg ulcers (VLUs), including improving calf muscle pump function1 and the principles of Wound Bed Preparation2. It incorporates new research findings in two key areas –
• The use of the muscle pump activation device (MPA – geko™, Firstkind Ltd, United Kingdom) that has been shown to improve the function of the calf muscle pump in patients with VLUs3. The standard way of improving calf muscle pump function is with compression therapy on the lower leg and new research has shown that when MPA is added to compression therapy, VLUs heal at a faster rate4. MPA is recommended for patients who cannot tolerate optimal compression therapy; or for patients whose ulcers are not healing or are slow to heal with the use of optimal compression therapy.
• An algorithm for the use of new and advanced wound therapies that can enhance the healing process of VLUs once the underlying cause of the impaired calf muscle pump has been optimally treated5. These advanced wound therapies are recommended to be used in a stepwise fashion, the key categories are –
– Eradication of biofilm and bacteria
– Reduction of increased protease levels
– Improvement in the wound base by Negative Pressure Wound Therapy or by adding matrix substitutes
– Addition of growth promoting factors to the wound bed
– Addition of healthy cells to the wound such as skin grafts, cultured cells or stem cells
The Consensus Statement also provides guidance to Health Care Providers on the steps to take if VLUs do not enter a healing phase or if the rate of healing is very slow.
The key components of the Consensus Statement are –
• Clinical assessment
• Investigations
• Diagnosis
• Treatment of the underlying cause which is impaired calf muscle pump function
• Management of the ulcer
• Options when not entering a healing trajectory
• Management post ulcer healing
The Consensus Statement has been presented at a number of national annual conferences including Nurses Specialized in Wound Ostomy and Continence Canada, Wounds Canada and the Canadian Society of Vascular Surgery. To date it has received the following endorsements:
Endorsed by Nurses Specialized in Wound, Ostomy and Continence Canada, 2024
The Canadian Home Care Association (CHCA) endorses the Canadian Consensus Statement on the Treatment of Venous Leg Ulcers as an essential resource for standardized care, complemented by CHCA’s Project ECHO: Home and Community Care, to enhance providers’ capacity through training and networking. (Nadine Henningsen, CHCA CEO).
By Dr Michael Stacey
Dr Michael Stacey is a Vascular Surgeon, Hamilton Health Sciences and Professor, Department of Surgery, McMaster University