Surgery for venous leg ulcersBMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39261.651655.47 (Published 12 July 2007) Cite this as: BMJ 2007;335:55
- Charles N McCollum, professor of surgery
- Education and Research Centre, University Hospital of South Manchester, Manchester M23 9LT
Venous leg ulcers are painful, malodorous sores that impair quality of life and are difficult to treat.1 An estimated 5-8% of the world's population have venous disease, and 1% have venous ulcers at some time in their life.2 The cost to healthcare services is best known for the United Kingdom, where active ulcers affect 1.7% of the elderly population, at a cost to the NHS of around £600m (€890m; $1200m) a year.3 4 Available evidence suggests costs are high throughout Europe, the United States, and Australia. These ulcers are caused by sustained high venous pressures due to venous disease, obesity, immobility associated with arthritis, or even old age itself.
Compression using four layer bandaging is the mainstay of treatment—it completely heals ulcers in a mean of 7-8 weeks when delivered by trained leg ulcer nurses in the community.5 6 The efficacy of four layer bandaging is not influenced by the underlying venous abnormality.7 Whether novel “biologically active” dressings can improve these healing rates remains uncertain, as …