• Ideally, uncomplicated ulcers should be assessed at least weekly for the first 2 weeks. If healing is underway this can be extended to fortnightly or monthly, and then 3-monthly intervals thereafter. If there are any concerns about ulcer deterioration, then more regular inspection is needed.
• Dressings should be changed at least once a week. At the same time check for healing and compliance with compression therapy and ask about problems (mobility, sleep, mood, and independence).
• Ideally, when compression therapy is started, people should be re-assessed for skin complications within 24–48 hours.
• If there is delayed or no healing, identify problems which may need further treatment or referral:
• Assess how the person's age, mobility, diet, medication (immunosuppressive drugs), and co-morbidities (e.g. diabetes) may be influencing healing.
• Look for granulation, or fibrous or necrotic tissue and slough:
• Healthy granulation tissue is pink in colour (suggests healing).
• Unhealthy granulation tissue is dark red in colour, and often bleeds on contact (may suggest infection).
• Fibrous tissue (white or yellow shiny), eschar (dry, black necrotic tissue), or slough (cream coloured) indicates that the wound may require debridement.
• Look for varicose veins which may need surgery.
• Check for complications related to:
• The ulcer: cellulitis as well as sinus formation and fistula (both uncommon).
• Compression bandaging: pressure damage or arterial insufficiency. Compression bandages should be removed immediately if the person experiences a change in foot colour or temperature, or increased pain. Consider seeking further medical advice if there is no improvement after removing the bandages.
• The dressings applied: skin maceration or allergic contact dermatitis. Maceration is indicated by a marked cut off appearance. It is usually caused by the inability of the dressing to manage exudate, so consider more frequent dressing changes, or a change in dressing type, and protect the surrounding skin with the use of an emollient.
• Ask the person if they are adhering to lifestyle strategies such as elevating legs, limb exercises, regular walking, and losing weight (if needed).
• If the ulcer is not fully healed or deteriorating at 12 weeks, look for signs of arterial insufficiency and repeat Doppler studies, and refer.

In depth