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To study the prevalence of factor V Leiden mutation in patients with chronic venous insufficiency and venous leg ulcers, compared with a control group, and to find out whether factor V Leiden mutation is more frequent in patients with chronic venous insufficiency and a history of deep venous thrombosis.Design: A case control study.Setting: Three outpatient dermatological clinics.Patients: Ninety-two patients (37 men, 55 women) with venous leg ulcers and 53 control patients (23 men, 30 women).

The revised guideline of 2013 is an update of the 2005 guideline "venous leg ulcer". In this special project four separate guidelines (venous leg ulcer, varicose veins, compression therapy and deep venous disorders) were revised and developed simultaneously. A meeting was held including representatives of any organisation involved in venous disease management including patient organizations and health insurance companies. Eighteen clinical questions where defined, and a new strategy was used to accelerate the process. This resulted in two new and two revised guidelines within one year. The guideline committee advises use of the C of the CEAP classification as well as the Venous Clinical Severity Score (VCSS) and a Quality of life (QoL) score in the assessment of clinical signs. These can provide insight into the burden of disease and the effects of treatment as experienced by the patient. A duplex ultrasound should be performed in every patient to establish the underlying aetiology and to evaluate the need for treatment (which is discussed in a separate guideline). The use of the TIME model for describing venous ulcers is recommended. There is no evidence for antiseptic or antibiotic wound care products except for a Cochrane review in which some evidence is presented for cadexomer iodine. Signs of infection are the main reason for the use of oral antibiotics. When the ulcer fails to heal the use of oral aspirin and pentoxifylline can be considered as an adjunct. For the individual patient, the following aspects should be considered: the appearance of the ulcer (amount of exudate) according to the TIME model, the influence of wound care products on moisturising the wound, frequency of changing compression bandages, pain and allergies. The cost of the dressings should also be considered. Education and training of patients t improves compliance with compression therapy but does not influence wound healing rates.

Compression therapy and treating venous insufficiency is the standard of care for venous leg ulcers. The need for debridement on healing venous leg ulcers is still debated. Dressings are often used under compression bandages to promote faster healing and prevent adherence of the bandage to the ulcer. A wide range of dressings is available, including modern dressings with different kinds of biological activity. Microbial burden is believed to underlie delayed healing, but the exact role of microbiofilm in wound healing is uncertain. Before choosing a specific wound dressing, four main functions should be considered: (1) cleaning, (2) absorbing, (3) regulating or (4) the necessity of adding medication. There is no clear evidence to support the use of one dressing over another, as demonstrated by many Cochrane review studies. In addition, the prescriber should enquire about contact allergies that may also develop during wound treatment. It is shown that early intervention and early investment may reduce the cost of treatment. The choice of wound dressings should be guided by cost, ease of application and patient and physician preference and be part of the complete strategy. The role of the medical specialist is evident. Wound dressings matter as part of the optimal treatment in VLU patients.