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The Importance of Vascular Investigation and Intervention in Leg Ulcer Management

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Abstract

Chronic leg ulceration is a common condition which is time consuming to treat and has a significant impact on quality of life. Historically, there has been little consensus as to the most appropriate means of assessing and managing leg ulcers and this has contributed to the protracted healing times and multiple recurrent episodes associated with them.

The vast majority of chronic leg ulcers will have a vascular aetiology and developments in assessment techniques over the last 25 years have dramatically improved understanding in relation to their causality. Furthermore, non-invasive techniques such as duplex ultrasound, hand-held Doppler and photoplethysmography can help in identifying patients who might be suitable for further potentially corrective intervention.

Surgical correction of refluxing superficial veins is now recognised as essential to minimise recurrence of venous leg ulcers. The ESCHAR trial concluded that following ulcer healing, superficial venous surgery significantly reduced ulcer recurrence for patients who presented with superficial venous reflux alone or in combination with segmental deep reflux.

In the last decade, ultrasound guided foam sclerotherapy, laser, and radiofrequency ablation have become popular interventions. These less invasive techniques provide alternatives to surgery in the treatment of incompetent superficial veins.

Without doubt, a comprehensive assessment of the underlying aetiology is the key to achieving optimum patient outcomes. If investigated appropriately and corrective procedures performed, the recurrence of leg ulcers may be reduced by half.

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Author information

Authors and Affiliations

  1. Leg Ulcer Service, Cheltenham General Hospital, Sandford Road, Cheltenham, Gloucestershire, GL53 7AN, UK

    Colin Davies B.Sc.(Hons), M.Sc.

  2. Vascular Department, Cheltenham General Hospital, Sandford Road, Cheltenham, Gloucestershire, GL53 7AN, UK

    Keith Poskitt M.D., FRCS

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  1. Colin Davies B.Sc.(Hons), M.Sc.
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  2. Keith Poskitt M.D., FRCS
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Correspondence to Keith Poskitt M.D., FRCS .

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Editors and Affiliations

  1. School of Medicine, University of Southampton, Tremona Road, Southampton, SO16 6YD, United Kingdom

    Raj Mani

  2. Centro SERRA, Università di Pisa, Lungarno Pacinotti 43, Pisa, 56100, Italy

    Marco Romanelli

  3. Banaras Hindu University, Varanasi, New F. Jodhpur Colony 6, Varanasi, 221 005, India

    Vijay Shukla

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Davies, C., Poskitt, K. (2012). The Importance of Vascular Investigation and Intervention in Leg Ulcer Management. In: Mani, R., Romanelli, M., Shukla, V. (eds) Measurements in Wound Healing. Springer, London. https://doi.org/10.1007/978-1-4471-2987-5_1

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