The diagnosis and management of 689 chronic leg ulcers in a single-visit assessment clinic

• Published in: European journal of vascular and endovascular surgery 2003-05, Vol.25 (5), p.462-468
• Main Authors: Adam, D.J., Naik, J., Hartshorne, T., Bello, M., London, N.J.M.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Ambulatory Care; Chi-Square Distribution; Chronic Disease; Female; Humans; Leg ulcer; Leg Ulcer - diagnostic imaging; Leg Ulcer - etiology; Leg Ulcer - therapy; Male; Middle Aged; Prospective Studies; Single-visit clinic; Treatment Outcome; Ultrasonography, Doppler, Duplex
• ISSN: 1078-5884; 1532-2165
• DOI: 10.1053/ejvs.2002.1906

Objectives: accurate diagnosis is essential if patients with chronic leg ulceration are to receive optimal treatment. This prospective study describes the findings of a standardised assessment protocol and the initial management of a consecutive series of patients with chronic leg ulceration presenting to a single-visit leg ulcer assessment clinic. Methods: between January 1993 and January 1999, a total of 555 patients (220 men and 335 women of median age 73, range 28-95 years) with 689 chronic leg ulcers were assessed. Full clinical assessment, ankle:brachial pressure index and lower limb venous duplex scan were performed according to a standardised protocol and diagnostic and management data were recorded prospectively on a computerised database. Results: venous disease alone was responsible for 496 of 689 (72%) ulcers. Isolated superficial venous reflux (SVR) was identified in 52% of limbs and two-thirds of these had superficial venous surgery. Combined SVR and segmental deep venous reflux (DVR) was present in 13%, and full-length DVR was present in 33% of limbs. Nineteen (4%) limbs had deep venous stenosis or obstruction. Overall, superficial venous surgery was performed in 43% and compression bandages or hosiery alone were applied in 52% of limbs. Mixed arteriovenous ulceration was present in 100 (14.5%) limbs of which 56 had arterial revascularisation, 38 had superficial venous surgery and 23 had compression alone. Fifteen limbs with pure arterial ulceration had angioplasty (n = 13) or simple dressings alone (n = 2). Ulceration due to lymphoedema (n = 17), mixed lymphoedema and venous reflux (n = 11) and other causes (n = 50) were managed by compression, dressings or skin grafting. Conclusions: a standardised protocol of clinical and duplex assessment can lead to a diagnosis in 97% of chronic leg ulcers. Duplex is essential to confirm or exclude potentially correctable venous disease and allow tailored surgical intervention for those patients who many benefit. Eur J Vasc Endovasc Surg 25, 462-468 (2003)