Influence of a specialized leg ulcer service on management and outcome

Background: The organization of leg ulcer care is poorly defined in the community. This study assessed the overall influence of a specialized community service on management and outcome of chronic leg ulcers, irrespective of aetiology. Methods: Assessment and outcome of ulcers were compared in patient samples (n = 200) from East and West Gloucestershire, before and after the introduction of specialized clinics into East Gloucestershire, In clinics, vascular disease was routinely assessed by duplex scanning and determination of the ankle:brachial pressure index. Results: There was no coordinated community structure for the care of patients with leg ulcers before the service was introduced, and 74 and 67 per cent of limbs in East and West Gloucestershire respectively had aetiology undiagnosed. After introduction of the clinics, the 12-week healing rate increased from 12 to 22 per cent in East Gloucestershire (P = 0.05) and to 47 per cent in the specialized East Gloucestershire clinics (P < 0.001). The 12-month recurrence rate decreased from 50 to 41 per cent in East Gloucestershire and to 17 per cent in the East clinics (P < 0.001). The West Gloucestershire control showed no significant changes. Conclusion: A specialized leg ulcer service with defined protocols provides an improved management structure for treating patients with leg ulcers in the community. Accurate diagnosis of chronic leg ulcers and improved outcome may be achieved within this specialized service.