" Bed rest with elevation of the leg at home or in the hospital; in persons who have severe edema, bed rest for 5-7 days helps to resolve the edema
" Antibiotics (oral or intravenous) if cellulitis is present; cellulitis is infection of the skin and underlying tissue
" Hydrocortisone cream applied to area immediately surrounding the wound but not the wound itself
" Local wound care with soap and water and application of dry gauze dressing
" Below-knee elastic compression stockings, to be worn at all times for life except at bedtime (Figure 1)

Figure 1

Figure 1. Dry gauze dressing with foam wedge over the ulcer helps to provide an even compression. A shorty nylon stocking placed over the dressing helps to hold it in place. This stocking has a side zipper.(From Gloviczki P, Yao, JST, eds. Handbook of Venous Disorders, 2nd ed. London: Arnold, 2001:304, Fig. 30.1.)

Wearing compression stockings may be difficult at first. Patients usually wear them for as long as they can tolerate them in the beginning, then gradually increase the time that they wear them. Sometimes the physician will fit the patient with lesser-strength stockings, followed by stockings with greater compression.

Silk inner toe liners, stockings with zippered sides, and other devices to help put on the elastic stockings are especially helpful for elderly patients or those who have trouble putting on compression stockings (Figure 2).

Figure 2 (a)

Figure 2 (b)

Figure 2. Silk liner (a) and Butler® device (b) are helpful in applying compression stockings.(Awaiting permission from Mayberry JC, Moneta GL, Taylor LM Porter JM. Nonsurgical treatment of venous stasis ulcer. In Bergan JJ, Yao JST, eds. Venous Disorders. Philadelphia: WB Saunders, 1991:381-385.)

Some patients cannot tolerate compression stockings. In this case, one of the following compression devices may be worn.