title: Long term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (ESCHAR): randomised controlled trial.
abstract: OBJECTIVE
  To determine whether recurrence of leg ulcers may be prevented by surgical correction of superficial venous reflux in addition to compression.
  
  
  METHODS
  Randomised controlled trial.
  
  
  METHODS
  Specialist nurse led leg ulcer clinics in three UK vascular centres.
  
  
  METHODS
  500 patients (500 legs) with open or recently healed leg ulcers and superficial venous reflux.
  
  
  METHODS
  Compression alone or compression plus saphenous surgery.
  
  
  METHODS
  Primary outcomes were ulcer healing and ulcer recurrence. The secondary outcome was ulcer free time.
  
  
  RESULTS
  Ulcer healing rates at three years were 89% for the compression group and 93% for the compression plus surgery group (P=0.73, log rank test). Rates of ulcer recurrence at four years were 56% for the compression group and 31% for the compression plus surgery group (P<0.01). For patients with isolated superficial reflux, recurrence rates at four years were 51% for the compression group and 27% for the compress plus surgery group (P<0.01). For patients who had superficial with segmental deep reflux, recurrence rates at three years were 52% for the compression group and 24% for the compression plus surgery group (P=0.04). For patients with superficial and total deep reflux, recurrence rates at three years were 46% for the compression group and 32% for the compression plus surgery group (P=0.33). Patients in the compression plus surgery group experienced a greater proportion of ulcer free time after three years compared with patients in the compression group (78% v 71%; P=0.007, Mann-Whitney U test).
  
  
  CONCLUSIONS
  Surgical correction of superficial venous reflux in addition to compression bandaging does not improve ulcer healing but reduces the recurrence of ulcers at four years and results in a greater proportion of ulcer free time.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN07549334 [controlled-trials.com].
authors.affiliation: Cheltenham General Hospital, Cheltenham, Gloucester GL53 7AN.
authors.forename: Manjit S
authors.initials: MS
authors.lastname: Gohel
authors.forename: Jamie R
authors.initials: JR
authors.lastname: Barwell
authors.forename: Maxine
authors.initials: M
authors.lastname: Taylor
authors.forename: Terry
authors.initials: T
authors.lastname: Chant
authors.forename: Chris
authors.initials: C
authors.lastname: Foy
authors.forename: Jonothan J
authors.initials: JJ
authors.lastname: Earnshaw
authors.forename: Brian P
authors.initials: BP
authors.lastname: Heather
authors.forename: David C
authors.initials: DC
authors.lastname: Mitchell
authors.forename: Mark R
authors.initials: MR
authors.lastname: Whyman
authors.forename: Keith R
authors.initials: KR
authors.lastname: Poskitt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003131:Combined Modality Therapy / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055502:Secondary Prevention; D053828:Stockings, Compression; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000628:therapy*; D014656:Vascular Surgical Procedures / Q000379:methods*; D014945:Wound Healing