title: Influence of a specialised leg ulcer service and venous surgery on the outcome of venous leg ulcers.
abstract: OBJECTIVE
  To assess the influence of a vascular-led community service on the outcome of chronic leg ulcers.
  
  
  METHODS
  Before and after study.
  
  
  METHODS
  Healing and recurrence were compared between ulcerated limbs (n = 149) from a random sample of 200 patients treated in the community and consecutive limbs (n = 200) from 180 patients treated in specialised clinics. In these clinics, vascular disease was routinely identified with venous duplex and ankle-brachial pressure index. Surgery was offered if superficial vein reflux alone was detected. Compression bandaging was applied to limbs with ABPI > 0.85. Healed limbs were treated with compression hosiery.
  
  
  RESULTS
  After the clinics were introduced, the 12 and 24-week healing rates increased from 12 and 29 per cent to 53 and 68 per cent respectively (p < 0.01), and the 6 and 12 month recurrence rates decreased from 43 and 54 per cent to 21 and 23 per cent respectively (p < 0.01). Superficial venous surgery reduced recurrence at 1 year to 9 per cent.
  
  
  CONCLUSIONS
  Outcome of leg ulcers is improved in a vascular-led community service. Routine surgical correction, in cases of reflux limited to the superficial system, may further reduce the chance of recurrence.
authors.affiliation: Cheltenham General Hospital, Gloucestershire, U.K.
authors.forename: A S
authors.initials: AS
authors.lastname: Ghauri
authors.forename: I
authors.initials: I
authors.lastname: Nyamekye
authors.forename: A J
authors.initials: AJ
authors.lastname: Grabs
authors.forename: J R
authors.initials: JR
authors.lastname: Farndon
authors.forename: M R
authors.initials: MR
authors.lastname: Whyman
authors.forename: K R
authors.initials: KR
authors.lastname: Poskitt
mesh_terms: D000368:Aged; D000556:Ambulatory Surgical Procedures; D001458:Bandages; D003153:Community Health Services; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D010044:Outpatient Clinics, Hospital; D015397:Program Evaluation; D012008:Recurrence; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000453:epidemiology / Q000601:surgery* / Q000628:therapy; D014945:Wound Healing