Study compared dressing techniques in selected group of patients

EDITOR —Morrell et al conducted a randomised controlled trial assessing the cost and clinical effectiveness of community leg ulcer clinics.1We are concerned that the trial design precludes a meaningful assessment of the value of these clinics.

Sixty five patients were excluded because they were unable to travel to the clinic, and they did not undergo any formal assessment; these patients still require a home visiting nursing service. It is unreasonable to conclude that a clinic based service is more cost effective when 16.5% of those requiring treatment were excluded from the study owing to immobility. It would have been more valuable to transport half of these patients to the clinic and include those costings in the analysis. Treatment effectiveness would be better assessed by comparing treatment with the Charing Cross bandaging technique2in the clinic with the same treatment in the home. The patients treated at home received a variety of other treatments.

Each patient underwent arterial pressure assessment, but there is no reference to any assessment of the venous system. A patient presenting with a venous ulcer of three months duration should at least undergo handheld Doppler assessment and ideally Duplex Doppler examination to exclude superficial venous reflux amenable to surgical correction. Isolated superficial venous incompetence may be present in 39% of those patients presenting with venous ulceration.3 This omission may account for the lower healing rate seen in the clinic group compared with theresults of other studies 2 4 and will certainly influence the recurrence rate in what is essentially a comparison of ulcer dressing techniques in a selected group of patients.

Study's comparison was outdated

EDITORCompression bandaging is the most effective form of treatment for …