Community clinics for leg ulcers and impact on healing.
OBJECTIVE
To evaluate the effectiveness of community clinics for leg ulcers.


METHODS
All patients with leg ulceration were invited to community clinics that offered treatment developed in a hospital research clinic. Patients without serious arterial disease (Doppler ankle/brachial index > 0.8) were treated with a high compression bandage of four layers.


METHODS
Six community clinics held in health centres in Riverside District Health Authority supported by the Charing Cross vascular surgical service.


METHODS
All patients referred to the community services with leg ulceration, irrespective of cause and duration of ulceration.


METHODS
Time to complete healing by the life table method.


RESULTS
550 ulcerated legs were seen in 475 patients of mean (SD) age 73.8 (11.9) years. There were 477 venous ulcers of median size 4.2 cm2 (range 0.1-117 cm2), 128 being larger than 10 cm2. These ulcers had been present for a median of three months (range one week to 63 years) with 150 present for over one year. Four layer bandaging in the community clinics achieved complete healing in 318 (69%) venous ulcers by 12 weeks and 375 (83%) by 24 weeks. There were 56 patients with an ankle/brachial arterial pressure index < 0.8, indicating arterial disease. The 50 patients with pressure index < 0.8 > 0.5 were treated with reduced compression, and 24 (56%) healed by 12 weeks and 31 (75%) by 24 weeks. The figures for overall healing for all leg ulcers were 351/550 (67%) at 12 weeks and 417/550 (81%) at 24 weeks, compared with only 11/51 (22%) at 12 weeks before the community clinics were set up.


CONCLUSIONS
Community clinics for venous ulcers offer an effective means of achieving healing in most patients with leg ulcers.
Moffatt
C J
CJ
Department of Surgery, Charing Cross Hospital, London.
Franks
P J
PJ
Oldroyd
M
M
Bosanquet
N
N
Brown
P
P
Greenhalgh
R M
RM
McCollum
C N
CN
D000368:Aged; D000553:Ambulatory Care; D001458:Bandages; D003153:Community Health Services; D005260:Female; D006801:Humans; D008297:Male; D013997:Time Factors; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D014945:Wound Healing