• Do you have a leg ulcer?
  • Do know someone who has a leg ulcer?
  • Do you treat or see patients with venous leg ulcers?
Leg Ulcer Treatment Revolution - by Prof Mark Whiteley

Leg Ulcer Treatment Revolution – by Prof Mark Whiteley

If the answer to any of these questions above is “yes” then you need to read “Leg Ulcer Treatment Revolution“.

Most venous leg ulcers can now be cured.

This means that most leg ulcers can now be treated with local anaesthetic endovenous surgery. When treated this way, the leg ulcer heals and not come back again.

This is not the same as traditional dressings and compression. Compression and dressings do not change the underlying cause of the ulcer. As soon as they are removed, the venous leg ulcer starts to return.

When a venous leg ulcer is cured by endovenous surgery, the venous system is put back to normal. If the patient is walking, this means they get back to a normal leg with no ulcer. The majority of people do not need compression stockings or bandages to keep it healed.

Ulcer dressings and compression bandages do not cure ulcers.

Bandages and dressings can help a leg ulcer to heal when they are on the leg. However, as soon as they are removed, any benefit is also removed. This allows to the ulcer to come back.

By NICE clinical guidelines CG 168, anyone with a leg ulcer should be referred to a specialist team. Not  a group of nurses working in a wound clinic. Nor a single doctor doing their own scan.

NICE states patients should be referred to a “vascular service”. This means a team who deal with venous leg ulcers.  This team should comprise a consultant surgeon or interventional radiologist who is able to perform endovenous surgery. There should be a vascular technologist who is an expert at scanning veins. There should be expert nurses who work with the team to ensure that those that are curable are cured. Only those who are incurable should end up having compression.

What happens to most patients with venous leg ulcers currently?

Most patients with venous leg ulcers get referred directly to nurses who are taught to use dressings and compression. Patients do not get a venous duplex ultrasound scan. Instead, they only get a very simple arterial Doppler pressure test. This tells nothing about the veins. However, about 90% of leg ulcers are due to vein problems (see: What sort of leg ulcer do I have?).

Therefore, most patients never get told that they could be cured by local anaesthetic surgery.

In the UK, the law on consent has changed. Any professional seeing a patient must inform the patient of all available treatments, even if they do not offer that treatment themselves. Therefore, every patient with a venous leg ulcer should be informed that they might be curable with endovenous surgery.

In addition, in the UK the NICE clinical guidelines CG 168 state who should be referred and where to. It states that anybody who has a venous leg ulcer, even if it is healed, should be referred to a “vascular service”. This is defined as a team of doctors, vascular technologist and nurses can scan the veins with duplex ultrasound and can perform all sorts of endovenous surgery.

Leg ulcer treatment revolution.

Patients with venous leg ulcers often have a rotten life. They have a constant wound requiring constant compression dressings, restricting their activities. This impacts their family, friends, work life and relationships. In addition, it is more expensive to continually provide dressings and compression for leg ulcers then it is to have local anaesthetic surgery.

Leg ulcer treatment revolution is a simple book written by Prof Mark Whiteley, a venous specialist and founder of the leg ulcer charity.

In simple language, it goes through what a venous leg ulcer is. It explains the difference between a venous leg ulcer and any other sort of wound. It explains the underlying causes for a venous leg ulcer. Using simple line diagrams, it also explains treatments. It explains which treatments help temporarily and which ones can produce a permanent cure.

Written in simple english it can be read by the public as well as health care professionals.

Leg ulcer treatment revolution – Mark S Whiteley – ISBN: 978-1908586056