Improving the diagnosis of chronic leg ulcers: a one-stop vascular assessment clinic in a community service

Objective: To evaluate the influence of a specialized vascular-led community leg ulcer service on assessment and diagnosis of leg ulcers. Design: Before-and-after study with prospective and retrospective data collection. Setting: East Gloucestershire, England, UK. Subjects: Patients treated for chronic leg ulcers before and within a specialized service incorporating a one-stop assessment including ankle-brachial pressure index (ABPI) and colour venous duplex. Main outcome measures: The means of assessment and the identified aetiology of leg ulcers in community patients. Results: Before clinics, only 40 (26%) limbs had a diagnosis recorded. After clinics, 83 (21%) limbs had arterial disease, including 64 (16%) with mixed arterial/ venous disease. Venous duplex identified 279 (70%) limbs with venous disease of which 121 (43%) had superficial venous disease alone. Conclusion: A one-stop assessment clinic with ABPI and colour venous duplex ultrasound within a specialized community service improves diagnosis of leg ulcers. This is essential before appropriate and safe management by specialist nurses in the community.