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Assessment and Management of Venous Leg Ulcers<br />
Current Ulcer(s)<br />
(Locate ulcer site by an X and number each leg ulcer on the diagram below)<br />
RIGHT<br />
Medial Anterior Lateral<br />
LEFT<br />
Medial Anterior Lateral<br />
94<br />
Zone<br />
3<br />
2<br />
1<br />
Zone<br />
3<br />
2<br />
1<br />
Right<br />
Medial<br />
Lateral<br />
Posterior<br />
Anterior<br />
Plantar<br />
Zone 1 Zone 2 Zone 3 Left<br />
Medial<br />
Lateral<br />
Posterior<br />
Anterior<br />
Plantar<br />
Zone 1 Zone 2 Zone 3<br />
Leg Ulcer Assessment<br />
Client: __________________<br />
Ulcer # Ulcer # Ulcer # Ulcer #<br />
Date of Onset: Year/Month/Day<br />
Please indicate when each ulcer first started. This may be<br />
an estimate if client is uncertain.<br />
Ulcer margins<br />
1. Well defined, punched out<br />
2. Diffuse irregular<br />
3. Cliff – like edges<br />
4. Rolled edges<br />
Odour<br />
0. None<br />
1. Slight<br />
2. Offensive<br />
© Loeb Health Research Institute, Clinical Epidemiology Unit<br />
Reprinted with permission.<br />
Ottawa-Carleton Community Care Access Centre Leg Ulcer Care Protocol Task Force (2000). Ottawa-Carleton<br />
Community Care Access Centre (CCAC) venous leg ulcer care protocol: Development, methods and clinical<br />
recommendations. Ottawa, Ontario: Ottawa-Carleton CCAC Leg Ulcer Protocol Task Force.
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