Chronic ulceration of the leg

The assessment and treatment of patients with chronic leg ulcers represents an enormous clinical and financial burden to community and secondary care services in the United Kingdom. Most leg ulcers are due to chronic venous hypertension, although arterial compromise, malignancy and vasculitis are also recognized causes. The assessment of patients with chronic leg ulceration should include a detailed history and clinical examination, supported by relevant investigations. Ankle brachial pressure index measurement and non-invasive venous (±arterial) imaging using colour duplex are the principal investigations. The mainstay of treatment for patients with chronic venous ulceration is multilayer compression bandaging, applied by trained staff working within a specialist service bridging primary and secondary care settings. Endovenous treatment of superficial venous reflux may also play an important role in improving outcomes. Patients with arterial compromise may require endovascular or surgical revascularization to promote healing. In this article, the causes, assessment and management of patients with chronic leg ulceration are discussed.