Improving the treatment of leg ulcers

• Treatment of leg ulcers is often inadequate, with delayed diagnosis, overuse of antibiotics, and insufficient or inadequate use of compression therapy. • Ulcers caused by arterial insufficiency will not heal unless the blood flow is improved. • Ulcers caused by venous insufficiency will usually heal within a few months with appropriate compression therapy. • Compression can be applied with stockings, bandages, or a pump. • Class 2 compression stockings are required for treatment of ulcers; TED stockings and Class 1 stockings do not provide adequate compression. • A four‐layer compression bandage can be used if a patient cannot manage stockings. Applying the bandage with the correct pressure is a skill developed from practice. • A pump can be used if neither stockings nor bandages are suitable. However, it must be used for six hours a day, which precludes use by active patients. • An ulcer that does not heal with three months of adequate compression therapy requires further investigation.