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Leg ulcer guidance

RSM’s Venous Forum issues leg ulcer guidance

Chronic wound care is estimated to cost between £4.5- £5.1 billion per year - a third of these wounds are leg ulcers
All patients should be referred to a vascular service for assessment of their veins

The Royal Society of Medicine’s Venous Forum (UK) has issued a guidance document for the ‘Management of patients with Leg Ulcers, to ensure that all patients with leg ulceration are offered the most appropriate care. In the guidance document, the Venous Forum state that leg ulcers continue to cause great distress to patients, cost the NHS millions of pounds each year and the prevalence of leg ulcers is increasing. For example, chronic wound care is estimated to cost between £4.5- £5.1 billion per year - a third of these wounds are leg ulcers.

Despite evidence-based guidelines for referral and treatment, the document states that current service provision remains poor. With that in mind, the document emphasises that leg ulcer all patients require specialist assessment, most patients have an underlying vascular cause for their leg ulcers and most would benefit from compression and treatment of their veins.

Leg ulcers are non-healing wounds on the lower leg usually due to an underlying problem with veins (and sometimes the arteries) and most leg ulcers are caused by chronic venous hypertension. Although leg ulcers usually take many months to heal, without appropriate care up to two-thirds of healed ulcers will recur within a year. Most patients with leg ulcers are managed in community healthcare settings however, data from GP records suggest that at least half these patients do not receive the care they need.

The guidance recommends that:

  • Every patient with a leg ulcer should have an ankle brachial pressure index (ABPI) assessment (‘Doppler’) on initial presentation to assess the arterial circulation, as Doppler assessment of ABPI is a valid and reliable way to detect arterial impairment in the lower limb.
  • All patients with an adequate arterial supply (ABPI>0.9) should be offered effective compression, as good compression doubles the chance of healing venous leg ulcers.
  • All patients should be referred to a vascular service for assessment of their veins.
  • All patients with treatable venous hypertension should be offered minimally invasive endovenous interventions (such as endothermal ablation or foam sclerotherapy), because superficial venous treatment halves the risk of ulcer recurrence.

To access the guidance document, please click here