Prospective comparison of recurrent venous ulceration after superficial surgery or compression bandaging

Background: The purpose of this prospective study was to investigate and compare the recurrence rate of venous ulcers treated by superficial surgery or compression bandaging. Methods: Patients received treatment for ulcers between May 1994 and July 1997. All legs in the study had an ankle: brachial pressure index above 0·8. The superficial surgery group consisted of 91 legs with superficial venous incompetence and normal deep veins which healed after superficial surgery. This group did not receive postoperative compression bandaging or hosiery. The community compression bandaging group consisted of 152 legs that healed during the recruitment period. A recurrent ulcer was defined as a further episode of venous ulceration in a previously healed leg. Patient follow‐up was by surgeons, district nurses' telephone call and/or letter. Recurrence rates were calculated by life‐table analysis (Kaplan–Meier). Patients who died or were lost to follow‐up were censored to their last visit. Results: The recurrence rate in the superficial surgery group at 1 and 2 years was 3 and 6 per cent respectively, compared with 26 and 33 per cent respectively in the compression bandaging group. The differences between the superficial surgery and compression bandaging groups were statistically significant ( P = 0·00001, log rank test). Conclusion: Ulcer healing after superficial surgery is sustained in the absence of postoperative compression. Conversely, the ulcer recurrence rate after compression bandaging is very high, probably because the underlying venous abnormality has not been corrected. The follow‐up of this study needs to be continued to 5 years, but the data so far suggest that a prospective randomized study comparing superficial surgery with compression bandaging is required. © 2000 British Journal of Surgery Society Ltd