“I’ve had this weepy sore on my ankle for weeks and it won’t heal — can you just bandage it up tight?”

Assess a chronic LEG ULCER by distinguishing VENOUS ulcers (over the medial GAITER area, shallow with sloping edges, exudative, surrounded by haemosiderin staining, varicose eczema and oedema, relatively less painful, with palpable foot pulses) from ARTERIAL ulcers (distal sites/pressure points, "punched-out", deep, painful especially at night and on elevation, cold/pale foot, absent/weak pulses) and neuropathic ulcers (pressure points in diabetics), using recorded findings from the nurse (photograph, pulses, capillary refill, sensation) when consulting remotely and arranging ABPI. The safety-critical, examinable point is that although COMPRESSION is the mainstay of venous-ulcer healing, the ANKLE-BRACHIAL PRESSURE INDEX (ABPI) must be measured before STRONG compression to exclude significant arterial disease (NWCSP: mild compression of 20 mmHg or less can start straight away if there are no red flags, with ABPI normally within 14 days) — applying compression to a leg with arterial insufficiency can cause ischaemia, necrosis and limb loss — so "just bandage it up tight" is unsafe until arterial supply is confirmed adequate (broadly ABPI ~0.8–1.3 acceptable; outside that → vascular referral, no/modified compression). Keep the must-not-miss in mind: a non-healing or atypical ulcer (rolled/everted edges, exuberant granulation, bleeding) may be a skin malignancy (SCC, including Marjolin’s ulcer in chronic wounds/scars) warranting biopsy/specialist assessment, and reconsider the diagnosis if a "venous" ulcer fails to heal. Once ABPI confirms adequate supply, manage the venous ulcer via the leg-ulcer/tissue-viability/district-nursing service (graded compression, wound care/dressings, elevation and oedema management, varicose-eczema treatment, venous-disease assessment, with vascular referral for an ulcer not healed within 2 weeks per NICE CG168), treating infection with antibiotics only if clinically infected (NICE NG152). Advise on lifestyle/prevention (weight, mobility, elevation, skin care, post-healing compression hosiery as venous ulcers recur). The hidden agenda is the wish to be "bandaged tight"; explain why ABPI must come first, set realistic expectations of slow healing, and safety-net for infection/arterial compromise. A typical venous ulcer does not need a NICE NG12 suspected cancer pathway referral, but a non-healing/atypical ulcer prompts biopsy, and NG12 advises considering a suspected cancer pathway referral for a skin lesion that raises the suspicion of SCC.