Venous insufficiency and ulcers Quiz: Ace Your Exams

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A 45-year-old woman presents to the clinic for evaluation of a skin ulcer on the right leg. The patient previously had a deep vein thrombosis of the right leg and subsequently developed progressive edema. The patient is no longer on anticoagulation. The patient has had no recent trauma to the leg and no recent fevers. Temperature is 37.0°C (98.6°F), heart rate is 68/min, respiratory rate is 14/min, blood pressure is 120/78 mmHg, and oxygen saturation is 100% on room air. On physical examination, there is dependent pitting edema of the right lower extremity to one-third of the way up the tibia. An ulceration is present above the medial malleolus with irregular borders and overlying fibrinous exudate. The area is mildly tender to palpation, but there is no warmth or fluctuance. This skin is mildly darkened, but no erythema is present. Which of the following is the best next step in management?  

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