Caring for patients with chronic leg ulcer

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Abstract
Leg ulcers are common, disabling, resistant to treatment, and expensive to manage. There is debate, not just about how to treat them but where. Recently, the trend has been towards treating patients almost exclusively in the community, leaving it to trained community nurses armed with evidence based protocols and pocket Doppler devices. The diversion of resources away from specialist care in hospitals, as well as being politically motivated, has been driven by clinical trials showing that community treatment can work: ulcer healing rates can improve as much as 70% over 3–6 months when care is provided by trained nurses in dedicated clinics using improved bandaging systems.1 2 3 4 These benefits are, however, short term. The longer term prospects for patients treated in this way are more uncertain. Health professionals and managers should not continue to divert resources from hospitals into the community before, firstly, taking account of the epidemiology of the condition and, secondly, considering the likely negative impact on important new advances in management. The aetiology of chronic leg ulcers is multifactorial. Data on the natural course of the disease …

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