Diagnosing and Managing Venous Stasis Disease and Leg Ulcers.

Venous insufficiency is a common medical condition that affects many individuals, especially those with advanced age. Chronic venous insufficiency can lead to secondary cutaneous changes that most commonly present as stasis dermatitis but can progress to more serious venous ulcers. Although venous ulcers are the most common cause of lower extremity ulcers, the differential diagnosis of leg ulcers is broad. This article will discuss clinical clues to help guide patient workup and will review basic clinical evaluation and management of common leg ulcers.

Clinical characteristics of Martorell hypertensive ischaemic leg ulcer.

OBJECTIVE: We sought to characterise the clinical picture of Martorell hypertensive ischaemic leg ulcer (HYTILU) by describing the ulcer borders with three clinical features: 'the red lipstick sign'; purple border; and livedo racemosa. We also aimed to characterise comorbidities and determinants of healing time. METHOD: A single-centre, retrospective cohort study was conducted between 2015-2020. We scrutinised ulcer photographs for relevant clinical signs. Data on comorbidities, medication and ulcer treatments, as well as method of diagnosis and healing time, were collected from patients' electronic medical records. RESULTS: In total, 38 female patients and 31 male patients (mean age 73 years) were assessed, with a mean follow-up time of 174 days. The 'red lipstick-like' margin covered 0-50% of the ulcer margin in 56.5% of the ulcers, and 51-100% of the ulcer margin in 43.5% of the ulcers. Purple border or livedo racemosa was observed in 70.5% of the ulcers. All patients had hypertension and 52.2% of patients had type 2 diabetes. A heavy cardiovascular disease burden and frequent concomitant vascular pathologies were found. Infections requiring systemic antibiotics, ulcer size and duration of symptoms before diagnosis were strongly associated with healing time. We also found that use of systemic corticosteroids and severity of hypertension (measured by the number of antihypertensive medications used) delayed healing. CONCLUSION: Our data suggest that 'the red lipstick sign' could be a novel diagnostic feature in HYTILUs alongside purple border, livedo racemosa and necrotic/fibrinous ulcer bed. The results also elucidated HYTILU comorbidities, and showed that infections and delay in diagnosis impeded healing.

Venous Ulcers: An Unusual Presentation of Iatrogenic Arteriovenous Fistula Caused by Lumbar Disc Surgery.

Iatrogenic arteriovenous (AV) fistula is a rare complication of lumbar disc surgery. We report a 38-year-old man who presented with bilateral lower limb venous ulcerations and was diagnosed with an AV fistula from previous L4-L5 laminectomy between the right common iliac artery and left common iliac vein, which was successfully treated using an endovascular stent graft.

Prevalence and predictors of combined >50% iliocaval venous obstruction and superficial venous reflux in chronic venous insufficiency patients with healed or active venous leg ulcer.

OBJECTIVE: The aim of the present study was to investigate the prevalence and predictors of combined >50% iliocaval venous obstruction (ICVO) and superficial venous reflux (SVR) in patients with chronic venous insufficiency (CVI) with a healed (C5) or an active (C6) venous leg ulcer (VLU). METHODS: We conducted a retrospective review of prospectively collected data from patients with CVI with CEAP (Clinical, Etiology, Anatomy, Pathophysiology) class C5 (healed ulcer) or C6 (active ulcer) with SVR who had been treated at our institution from February 2017 to January 2018. The demographic, clinical, and surgical data and duplex ultrasound and computed tomography venography findings were collected. We used OsiriX MD, version 2.9, software (Pixmeo SARL, Bernex, Switzerland) to measure the vein diameter via multiplanar reconstruction. The prevalence of combined >50% ICVO and SVR was evaluated, and univariate and multivariate analyses were performed to identify the independent predictors of >50% ICVO in patients with CVI and SVR. RESULTS: A total of 79 limbs from 67 patients were enrolled. The mean age was 59.82 ± 12.86 years, the mean body mass index was 28.68 ± 6.41 kg/m2, and 41.8% were men. The prevalence of >50% ICVO in the patients with SVR was 31.6%. Univariate analysis showed a history of deep vein thrombosis (DVT) in the affected leg (P = .001), a VLU in the left leg (P = .033), a history of a recurrent VLU (P = .038), and reversed flow in the superficial epigastric vein (P = .004) were significantly associated with >50% ICVO in patients with CVI and SVR. Multivariate analysis revealed a history of DVT in the affected leg (adjusted odds ratio [aOR], 8.31; 95% confidence interval [CI], 2.29-30.19; P = .001), a VLU in the left leg (aOR, 3.95; 95% CI, 1.18-13.19; P = .026), and a history of a recurrent VLU (aOR, 3.08; 95% CI, 1.02-9.32; P = .047) to be independently associated with combined >50% ICVO and SVR in patients with CVI. CONCLUSIONS: The prevalence of combined >50% ICVO and SVR in patients with CVI and CEAP C5 or C6 was 31.6%. The independent predictors of combined >50% ICVO and SVR in those with CVI were a history of DVT in the affected leg, a VLU in the left leg, and recurrent VLUs.

Stasis Dermatitis: An Overview of Its Clinical Presentation, Pathogenesis, and Management.

Stasis dermatitis is a chronic inflammatory skin disease of the lower extremities. It typically occurs in older individuals and is the cutaneous manifestation of venous hypertension caused by venous reflux. Such retrograde venous blood flow is the result of incompetent venous valves, valve destruction, or venous obstruction. Stasis dermatitis is eczematous. The associated impairment of venous valves may cause swelling of the legs, leading to serious conditions including venous ulcerations. Diagnosis can be challenging because of its clinical resemblance to other skin conditions and poor clinical recognition by physicians. The cornerstones of stasis dermatitis treatment are compression therapy to ameliorate pain and swelling, topical treatments to alleviate secondary skin changes, and interventional treatment options to correct the underlying causes of venous reflux. Given the central role of inflammation of the lower extremities in driving the cutaneous changes characteristic of stasis dermatitis, new therapeutic approaches that target the inflammation are under clinical evaluation in patients with stasis dermatitis.

Stasis dermatitis is a skin disease that can affect a person for a long time. It affects the legs of older people who have a disease called chronic venous insufficiency. This is when a person's veins have difficulty sending blood from their limbs back to their heart. Stasis dermatitis is caused by increased pressure inside a person's veins. Its signs and symptoms are skin discoloration, itch, dryness, and scaling and can be similar to the signs and symptoms of cellulitis and allergic contact dermatitis. Cellulitis is a common skin infection caused by bacteria. Cellulitis causes redness, swelling, and pain. Allergic contact dermatitis is an itchy skin rash caused by contact with something that irritates the skin. Stasis dermatitis is usually diagnosed after a healthcare provider has looked at person's skin and their medical history. Treatment for stasis dermatitis should treat the chronic venous insufficiency that causes the disease. It should also treat the skin lesions caused by stasis dermatitis. One way to treat stasis dermatitis is to reduce pain and swelling. This is done by applying pressure with compression stockings or bandages. Minor surgery can treat the venous insufficiency that causes stasis dermatitis. No treatments have been approved for the skin symptoms associated with stasis dermatitis. New ways to treat such symptoms need to be developed.

[Postthrombotic syndome-a complex clinical picture]. / Postthrombotisches Syndrom ­ ein komplexes Krankheitsbild.

Postthrombotic syndrome (PTS), which comprises a range of symptoms and signs following the development of deep vein thrombosis, is associated with varied clinical presentation. The functional limitations associated with PTS may be persistent, and following deep vein thrombosis, the patient may require lifelong anticoagulation. Venous ulceration is often regarded as a complication of PTS. However, the development of venous ulceration strictly depends on underlying venous hypertension, which is not always present. Due to the heterogenous clinical presentation of PTS, diagnosis may be difficult. Nevertheless, accurate diagnosis is vital and modern imaging techniques can help establish the diagnosis and play a role in monitoring treatment response. Thus, in addition to new strategies in compression therapy, (endo)vascular interventions are established treatment modalities in the management of PTS.

Comparison Between Numeric Parameters From Acute and Chronic Venous Leg Ulcers: Identification of Potential Objective Nonhealing Parameters.

BACKGROUND: Some authors claim that the clinical methods often employed to assess chronic venous leg ulcers (CVLU) are based on subjective interpretation. The treatments based on a subjective characterization could become a trial-and-error therapy, resulting in longer evolutions and high recurrence rates. PURPOSE: The aim of this work was to compare numeric parameters from acute and chronic venous leg ulcers to identify potential objective nonhealing parameters. METHODS: The study was performed with hospital outpatients from 2016 to 2019. Cohorts were established according to the ulcer evolution time. Data collected related to ulcer characteristics included exudate pH, lactate and glucose concentrations, temperatures, microbiology findings, and imaging study results. RESULTS: Approximately 83% of the examined ulcers were chronic. Seventy-one percent of CVLUs and 59% of the acute ulcers had a pH ≥8. A high variability was found for the concentration of glucose and lactate in exudates of both acute and chronic ulcers. Variations of temperatures of normal skin (ΔT1) and periulcer zone (ΔT2) in reference to the wound bed temperature with values above 1 could indicate the presence of an inflammatory process and be used as a new potential marker of inflammation. All the acute ulcers and 88% of CVLUs showed <80% of granulation tissue in the imaging study. Finally, more than 105 organisms per gram of tissuewere found in 100% of the analyzed samples. CONCLUSIONS: Whereas there were not significant differences among the clinical measured parameters between acute and chronic ulcers, further research on the use of objective measurable parameters is needed to establish cutoff points to differentiate the "chronic state" of an ulcer as a "nonhealing state" regardless of the evolution time. Also, the use of these easily obtainable and low-cost nonhealing parameters would be a new approach to accurately monitor this pathology.

Th17-Gene Expression Profile in Patients with Chronic Venous Disease and Venous Ulcers: Genetic Modulations and Preliminary Clinical Evidence.

Chronic venous disease is a condition globally widespread, resulting in a disabling pathological disorder. The CD4 + Th17+ (Cluster Differentiation 4) lymphocytes represent a regulative factor for innate immunity related to the development of complex diseases. Recently, these mechanisms have been associated with vascular disease. The aim of this work is to validate whether the Th17 response correlates with the development of CVI (Chronic venous insufficiency)and CVLUs (chronic venous limbs ulcers) and whether Th17 markers can be used, both as intrinsic risk factors and diagnostic markers, for disease development. PBL derived from peripheral blood samples of patients and controls were subjected to gene expression analysis for IL23R, IL17, SGK1, TGFß, RORγ, FOXO1, and RANBP1 by qRT-PCR and immunoblot. A post hoc correlation, the diagnostic performance of the target genes, and multivariable analyses were properly conducted. The main expression markers of the CD4 + Th17+ switch were strongly activated in chronic venous insufficiency and in advanced ulceration. The correlation analysis demonstrated the inter-dependence on Th17's signature modulation. ROC (Receiver Operating Characteristic) analysis defined, for the examined genes, a clinical value as the potential diagnostic markers. Multi-logistic regression studies showed that Th17 markers behave as empirical risk factors for CVD (chronic venous disease) development. Taken together, the present data provide a new hypothesis for the TH17-dependent pathogenesis of CVD, favoring the possibility for the development of new diagnostic, preventive, and therapeutic approaches.

Risk factors for the recurrence of venous leg ulcers in adults: A systematic review protocol.

BACKGROUND: Venous leg ulcers are slow to heal, and recurrence is frequent. Living with venous leg ulcers can affect physical and psychological health, and result in financial burden for individuals. Physiological and psychosocial factors are associated with venous leg ulcer recurrence. As over 50% of venous leg ulcers will recur within 12 months of healing, a comprehensive knowledge of holistic risk factors associated with recurrence is required by health professionals involved in the care of the person with venous leg ulcers. AIM: To develop a systematic review protocol to determine the risk factors for recurrence of venous leg ulcers in adults. METHOD AND ANALYSIS: This protocol was developed according to the Preferred Reporting Items Form Systematic Review and Meta-Analysis Protocols (PRISMA-P). The inclusion criteria will be based on the PICOS mnemonic-adults with a history of venous leg ulcer/s (participants), risk factor/s under physiological (general/medical), clinical, demographics, psychosocial categories (I (intervention) or E (exposure), venous leg ulcer non-recurrence (comparison group), venous leg ulcer recurrence (outcomes to be measured) and will include study designs of original qualitative, quantitative and mixed method studies (study designs to be included). Methodological quality will be assessed using the Mixed Methods Appraisal Tool. This Systematic Review Protocol was registered in PROSPERO [CRD42021279792]. RESULTS: If meta-analysis is not possible, a narrative review of results will be presented. CONCLUSIONS: This systematic review on recurrence of venous leg ulcers can provide evidence-based information for preventive strategies for recurrence of a healed venous leg ulcer. The standardised approach outlined in this systematic review protocol offers a rigorous and transparent method to conduct the review.

The economic impact of infection requiring hospitalization on venous leg ulcers.

OBJECTIVE: To determine the impact of infection (INF) on medical resource utilization (MRU) and cost of care in patients with venous leg ulcers (VLU). METHODS: We performed a retrospective case-control study of 78 patients followed for a minimum of 12 months with C6 VLUs treated by vascular surgeons, at our wound center. To eliminate minor episodes of INF or incorrectly diagnosed episodes, only patients who had an inpatient admission specifically for INF comprised the INF group, whereas all other admissions were excluded for this group. MRU was defined as the number of clinic visits, Visiting Nurse Association (VNA) visits, and inpatient admissions. The actual cost for treatment was determined using financial data provided by both the hospital and physician organization billing units. The total cost over the 1-year follow-up period comprised individual cost centers: inpatient and outpatient facility fees, physician fees, and visiting nurse services. Mean MRU and cost data were compared using the two-sample t-test between INF and NON-INF. RESULTS: Of the 78 patients with C6 VLU, 9 (11.5%) had at least one inpatient admission for INF related to their VLU in the 1-year treatment period, with an additional five recurrent admissions for a total of 14 admissions, whereas 69 NON-INF had three NON-INF-related admissions. There was no difference between INF and NON-INF for usual risk factors, but INF had a greater proportion of congestive heart failure (44%; 13%, P < .02). Regarding MRU, both the number of outpatient wound center visits (INF 16.89 ± 6.41; NON-INF 9.46 ± 7.7, P = .008) and VNA blocks (INF 3.89 ± 2.93; NON-INF 1.94 ± 2.24, P < .02) were greater for INF. Total costs for INF ($27,408 ± $10,859) were threefold higher than those for NON-INF ($11,088 ± $9343, P < .0001) and subsequent VNA costs were doubled for INF ($9956 ± $4657) vs NON-INF ($4657 ± $5486, P = .01). CONCLUSIONS: INFs in patients with VLU led to an overall increase in MRU and cost of care, with the INF cohort requiring more inpatient admissions, outpatient visits, and VNA services than NON-INF. Given the major impact INF has on cost and MRU, better treatment modalities that prevent INF as well as identifying risk factors for INF in patients with VLU are needed.

Multidimensional Pain Characteristics in Older Adults with Chronic Venous Leg Ulcers.

Objective: Pain affects wound healing, treatment, and quality of life because it has significant impacts on physical, psychological, and social well-being. Despite the fact that more than half of chronic venous leg ulcer (CVLU) patients experience mild-to-moderate pain, the multidimensional characteristics of CVLU pain are not well documented. The objective of this study was to describe the multidimensional pain characteristics, including the sensory, affective, cognitive, and behavioral dimensions, of CVLU before debridement. Approach: Participants (N = 40) were recruited from a wound clinic. We conducted a descriptive analysis of clinical data, including pain, wound, and demographic characteristics, collected at the first visit. Results: The mean age of participants was 70.8 ± 9.1 years, 22 (55%) participants were female, and 35 (87.5%) were white. Participants reported mean current pain intensity (2.9 ± 2.7), least (1.2 ± 2.2) and worst (4.8 ± 3.4) pain intensity in 24 h, and tolerable pain level (4.9 ± 2.64) on a 0-10 scale. They described pain as periodic (66.7%, n = 26) with multiple pain quality descriptors (5.4 ± 2.9). Their past pain treatments provided some pain relief (65%, n = 25). For 68% (n = 27), their pain was the same as they expected. Nearly all had a tendency not to tell others about their pain (95%, n = 38). Innovation: This study is the first to describe the multidimensional pain characteristics of patients with CVLU as measured with PAINReportIt. Conclusion: Patients with CVLU reported willingness to tolerate a relatively high level of pain and experience the level of pain they anticipate. Multidimensional pain assessment will assist clinicians to select individualized therapies to manage pain and improve quality of life for these patients.

Hemorragia fatal de una ulcera venosa crónica: Reporte de un caso / Fatal bleeding from a chronic venous ulcer: case report

Resumen La enfermedad venosa crónica es un trastorno común que se manifiesta con una amplia gama de signos. En casos en los que la enfermedad adquiere gravedad se le denomina insuficiencia venosa crónica y esta puede llevar al desarrollo de una úlcera venosa. Un trauma directo o la erosión de una vena varicosa pueden llevar a una hemorragia que, aunado a enfermedades crónicas concomitantes, factores toxicológicos, sociales o primeros auxilios inadecuados pueden llevar a la muerte en pocos minutos y en un escenario del crimen que puede ser confuso a primera vista para el equipo forense. Se reporta un caso valorado en la Sección de Patología Forense del Departamento de Medicina Legal del Poder Judicial de Costa Rica en el que se realizó una autopsia completa. Dentro de los hallazgos más importantes a nivel macróscopico se evidenció una úlcera cónica de características venosas en la pierna derecha en la cual, mediante la disección por planos y la inyección de colorante en la vena safena magna, se observó la salida de este por una vena varicosa relacionada con la úlcera.

Abstract Chronic venous disease is a common disorder that shows a large spectrum of signs. In cases in which the disease acquires severity it is named chronic venous insufficiency, and it can cause the development of a venous ulcer. Direct trauma to or erosion of a varicose vein can lead to a hemorrhage that, in combination with coexistent conditions, toxicologic or social factors, or inadequate first aid can produce death in few minutes and a crime scene which might be confusing at first sight to the forensics team. We present a case handled by the Forensic Pathology Section of the Department of Legal Medicine of the Judicial Power of Costa Rica in which a complete autopsy was performed. Among the most relevant macroscopic findings was evidence of a chronic ulcer with venous characteristics on the right leg, in which dissection by planes and dye injection into the great saphenous vein showed leakage of this dye out of a varicose vein related to the ulcer.

Avaliação da pentoxifilina e do sulfato ferroso no tratamento da úlcera varicosa dos membros inferiores / Evaluation of pentoxifylline and ferrous sulfate for treatment of lower limb venous ulcers

Resumo Contexto A úlcera varicosa (UV) é o estágio mais avançado da doença venosa crônica (DVC) dos membros inferiores (MMII), frequentemente associada a episódios de hemorragia que podem provocar anemia crônica (AC) e retardar a sua cicatrização. Não há, na literatura, trabalhos que avaliem a prevalência da AC nos portadores de UV dos MMII, e poucos trabalhos analisam o uso da pentoxifilina no tratamento das UV dos MMII. Objetivos Avaliar a prevalência da AC nos pacientes portadores de UV de MMII e a resposta terapêutica ao sulfato ferroso (SF) e a associação da pentoxifilina com SF no tratamento adjuvante das UV dos MMII. Métodos Foram avaliados 67 pacientes portadores de UV de MMII atendidos no ambulatório de Cirurgia Vascular do Hospital das Clínicas, Recife, PE. Após as avaliações clínica e laboratorial iniciais, os pacientes diagnosticados com AC foram randomizados em dois grupos: o grupo controle, que recebeu SF (900 mg/dia via oral), e o grupo de estudo, tratado com SF (900 mg/dia via oral) e pentoxifilina (1.200 mg/dia). Todos foram reavaliados após 90 dias. Resultados Entre os pacientes avaliados, 27 (40%) apresentavam AC. Após o tratamento, foram observados aumento dos níveis de hemoglobina e de hematócrito e melhora das taxas da cinética do ferro, assim como a diminuição da profundidade e da área das UV em ambos os grupos, sem diferença estatística. Conclusões Foi encontrada alta prevalência de anemia na população estudada. A associação do SF com a pentoxifilina não se mostrou mais eficaz do que o emprego isolado do SF no tratamento adjuvante da UV dos MMII.

Abstract Background Venous ulcers (VU) are the most advanced stage of chronic venous disease (CVD) of the lower limbs. They are frequently associated with episodes of hemorrhage that can provoke chronic anemia (CA), delaying healing. There are no studies in the literature analyzing the prevalence of CA among patients with VU of the lower limbs and few studies have analyzed use of pentoxifylline to treat VU of the lower limbs. Objectives To evaluate the prevalence of CA in patients with lower limb VU and responses to treatment with ferrous sulfate (SF) compared with a combination of SF plus pentoxifylline as adjuvant treatment for VU of the lower limbs. Methods A total of 67 patients with lower limb VU were recruited from a Lymphedema and Angiodysplasia Clinic at the Hospital das Clínicas, Recife, PE, Brazil. After initial clinical and laboratory assessments, patients diagnosed with CA were randomized into one of two groups: a control group, given SF (900 mg/day oral route), or a study group, treated with SF (900 mg/day oral route) and pentoxifylline (1,200 mg/day). All were reassessed after 90 days. Results Twenty-seven patients (40%) had CA. After treatment, increases were observed in hemoglobin and hematocrit levels, iron kinetics had improved, and both depth and area of VU had reduced in both groups, without statistically significant differences. Conclusions A high prevalence of anemia was detected in the study population. The combination of SF and pentoxifylline was not more effective than SF alone for adjuvant treatment of VU of the lower limbs.

An audience survey of practice relating to pain in the management of chronic venous leg ulcers.

Venous leg ulcers (VLU) respond well to compression, yet many ulcers remain unhealed after 1 year. Practitioners could be reluctant to apply compression to patients with significant ulcer pain. This study aimed to capture the views of practitioners on compression therapy for patients with painful VLU. A survey was conducted at a UK meeting in 2019 using handheld voting pads to capture the anonymous responses to four questions to which a mean of 90 practitioners responded. Nearly 40% of practitioners treat six or more patients a day with painful lower-limb ulcers. Some 80% felt confident in managing patients with painful ulcers; yet, most practitioners suggested they would refer onward for pain management. Some 40% would omit or reduce compression therapy as a pain management strategy. This survey supports the need for technological solutions that reduce VLU pain so that patients receive effective compression therapy.

Persistent venous leg ulcers complicated by linear morphea: a case report.

Soft tissue ulceration resulting from chronic venous insufficiency is a common condition that requires standardised long-term therapy, which has been thoroughly established. We report a patient with a five-year history of persistent venous stasis ulcers despite treatment consistent with traditional wound care. Resolution of the ulcers began only upon deviation from conventional therapy. This report considers non-standard treatments in patients with venous ulcers that do not progress.

Anthropometric, Biochemical, and Food Consumption Parameters are Associated with Venous Leg Ulcer Area and Duration.

OBJECTIVE: To describe the dietary habits and anthropometric and biochemical parameters of patients with active venous leg ulcers and to verify the association of these variables with wound duration and area. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study conducted with 33 participants diagnosed with venous leg ulcers in outpatient care. MAIN OUTCOME MEASURES: Socioeconomic data, anthropometric parameters, biochemical parameters, food consumption, and wound characteristics were analyzed by an interprofessional team. MAIN RESULTS: Participants were an average of 58 ± 13 years, 57.6% women, 84.8% overweight, and had a median wound duration of 10 months (range, 1-192 months) and an average wound area of 5 cm (range, 0.22-61.1 cm). Diets were typically hypocaloric and hypoproteic, with a low amount of vitamin A and magnesium. Wound duration was negatively associated with polyunsaturated fat intake (P = .032), whereas wound area was significantly associated with lipid intake (P = .002) and C-reactive protein (P = .040). CONCLUSIONS: Patients with active venous leg ulcers were overweight (leading to systemic inflammation) and had low consumption of calories, protein, and micronutrients that could support cicatrization. Wound area was associated with a high-fat diet, whereas wound duration was negatively associated with polyunsaturated fat intake.

Pain in persons with chronic venous leg ulcers: A systematic review and meta-analysis.

Pain is a serious problem for patients with leg ulcers. Research mainly focuses on dressing-related pain; however, chronic background pain may be just as devastating. Our main objective was to describe the prevalence and characteristics of wound-related background pain in persons with chronic venous leg ulcers. We performed a systematic review to synthesise data from quantitative studies. Studies were eligible if they reported original baseline- or cross-sectional data on background pain in chronic venous leg ulcers. The initial search identified 2454 publications. We included 36 descriptive and effect studies. The pooled prevalence of wound-related background pain (from 10 studies) was 80% (95% CI 65-92%). The mean pain intensity score (from 27 studies) was 4 (0-10 numeric rating scale) (95% CI 3.4-4.5). Other pain characteristics could not be synthesised. We identified few sufficiently high-quality studies on prevalence and intensity of wound-related background pain in patients with chronic venous leg ulcers. Four of five persons experience mild to moderate pain. Because of poor quality of pain assessment and report, we believe that the available research does not provide a sufficiently nuanced understanding of background pain in this patient group.