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Venous Leg Ulcer — SCE Dermatology MCQ

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HardWound HealingVenous Leg UlcerSCE Dermatology

A patient has an active gaiter-area venous ulcer present for 18 days, ABPI 0.96 and duplex evidence of superficial truncal reflux. Compression has started. Which referral decision matches NICE CG168?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Immediate vascular-service referral under the two-week active venous ulcer duration criterion

Explanation lettering: D = shown as A · E = shown as B · B = shown as D · A = shown as E

D is correct. NICE defines an active venous leg ulcer as a break in the skin below the knee that has not healed within two weeks and recommends referral to a vascular service. Compression remains important when arterial supply is adequate, but it does not replace assessment for treatable superficial venous reflux. Duplex ultrasound is used to confirm reflux and plan intervention. Waiting for twelve weeks, six months or complete healing delays management and increases recurrence risk. The two-week threshold relates to ulcer duration, not a mandatory failed trial of compression.

Reference: NICE CG168: varicose veins diagnosis and management: https://www.nice.org.uk/guidance/cg168/chapter/Recommendations