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Practice Therapeutics

Dressings for venous leg ulcers

BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k1604 (Published 02 May 2018) Cite this as: BMJ 2018;361:k1604
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Wound assessment and dressing choice for venous ulcers

Rapid Response:

Re: Dressings for venous leg ulcers

Re: Tate. S, Price. A, Harding. K, Dressings of Venous leg ulcers BMJ 2018;361:k1604 doi: 10.1136/bmj.k1604 (Published 2 May 2018)

The paper by KH and colleagues(1) concerning leg ulcers provides sensible advice about choosing dressings, but it fails to make any mention of the importance of addressing the underlying cause of ulcers, which should overshadow a narrow focus on dressings.

It has been known for over a decade that correction of superficial venous reflux reduces the likelihood of relapse from venous ulceration (2, 3).

There is also high-quality evidence that prompt correction of venous reflux achieves faster healing of venous ulcers and increases ulcer free time compared to compression therapy alone (4).

All patients with non-healing leg ulceration of two weeks duration should be referred to a vascular service for diagnosis, investigation and correction, whenever possible, of underlying superficial venous reflux (See NICE clinical guidelines 168(5) and the Royal Society of Medicine Venous Forum ulcer document guideline (6)).

Failing to recognise the importance of vascular referral, and focusing solely on local wound care, is an important reason that venous ulcers remain such a prevalent public health issue.

References
1. Tate S, Price A, Harding K. Dressings for venous leg ulcers. BMJ. 2018;361:k1604.
2. Barwell JR, Davies CE, Deacon J, Harvey K, Minor J, Sassano A, et al. Comparison of surgery and compression with compression alone in chronic venous ulceration (ESCHAR study): Randomised controlled trial. Lancet. 2004;363(9424):1854-9.
3. Gohel MS, Barwell JR, Taylor M, Chant T, Foy C, Earnshaw JJ, et al. Long term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (ESCHAR): Randomised controlled trial. BMJ. 2007;335(7610):83.
4. Gohel MS, Heatley F, Liu X, Bradbury A, Bulbulia R, Cullum N, et al. A Randomized Trial of Early Endovenous Ablation in Venous Ulceration. N Engl J Med. 2018.
5. Marsden G, Perry M, Kelley K, Davies AH. Diagnosis and management of varicose veins in the legs: Summary of NICE guidance. BMJ. 2013;347:f4279.
6. https://www.rsm.ac.uk/media/4410709/Management-of-Patients-with-Leg-Ulce...

Competing interests: No competing interests

18 May 2018
Ian J Franklin
Consultant Vascular Surgeon, Honorary Secretary Royal Society of Medicine Venous Forum
Council of the Royal Society of Medicine Venous Forum
Royal Society of Medicine Venous Forum
Venous Forum, Royal Society of Medicine, 1 Wimpole Street, London, W1G 0AE