An excruciating leg ulcer? Pile on the pressure

PATIENTS suffering from hard-to-treat leg ulcers may be able to find relief simply by applying pressure to the wound. New research has found that compression – tight bandaging in addition to elasticated stockings which apply constant pressure to simulate blood flow – is an effective option for a much larger number of ulcer types than was previously thought.

Half a million Britons suffer from a leg ulcer at any one time. These typically take four to six weeks to heal and, alongside discomfort, unsightly scarring is common.

It is estimated that one in 50 people aged 80 and over is affected at any given time.

As ulcers are open wounds, they are susceptible to bacteria and can become infected if not regularly attended.

Left untreated, they may never heal, with patients living with open wounds for years.

The cause of a foot or leg ulcer is either venous – caused by poor flow in the veins, which transports blood from the limb back to the heart – or arterial, caused by poor circulation in the arteries, which transports the blood out to the limbs, or a mix of both.

Some 80 per cent of ulcers are venous, and the ‘gold standard’ treatment for this is compression bandaging.

However, in up to 20 per cent of cases the patient also has a minor-to-moderate arterial disease – poor artery circulation – called peripheral arterial occlusive disease (PAOD).

As these patients’ ulcers have a venous cause, but they also suffer arterial problems, medical staff are taught not to use compression treatment as there is concern that this may cause gangrene – tissue death around the ulcer.

However, a study carried out at the Barbantini Clinic, in Lucca, Italy, found that it is safe to use compression bandages or stockings on mixed leg ulcers, meaning more people will be eligible for this treatment.

The subjects of the study were all patients with mixed leg ulcers whose arterial issues were found to be moderate, and who had not responded to other treatment.

As part of the study, they were treated as if they had only venous ulcers, with a standard injection treatment to the underlying veins and then with firm medical compression stockings.

These apply around four times the pressure of the typical travel sock that can be purchased in a High Street chemist. Tested against a group of patients with only venous leg ulcers who had the same treatment, the average healing time of the mixed leg ulcer patients was similar, about 24 weeks.

Professor Mark Whiteley, a consultant vascular surgeon and founder of the Leg Ulcer Charity, said: ‘Compression is the most basic treatment for a venous leg ulcer, but no nurse in the UK will put compression on a venous leg ulcer patient who also has some arterial disease for fear of causing gangrene.

‘As the cause is not arterial, they are not treated for this either, and instead these patients only have their ulcers dressed and redressed and sent home. But this means they will never heal.’

The professor added: ‘This research shows that it is safe to treat venous ulcer patients with minor to moderate arterial disease using compression – providing you follow the guidelines of correct use of pressure.

‘This allows us to not only to provide compression in these patients, but also use other techniques to treat the underlying veins.

‘In the past these people would have been refused treatment.

‘The research shows they can be helped, and potentially be cured in the long term.’