Approaches to venous leg ulcer care within the community: compression, pinch skin grafts and simple venous surgery.

The traditional approach to leg ulcer care is both expensive and achieves poor outcomes. The outcome of treatment for patients with venous ulceration has been improved using a more scientific and research-based approach to patient assessment, adequate compression bandaging, use of other procedures such as pinch skin grafting and simple venous surgery, and the delivery of these innovations in patient care to the community as a whole. Multi-layer compression bandaging is superior to standard (one-layer) bandaging because it can easily be adapted to a wide range of ankle circumferences and leg sizes to provide sustained, graduated compression. Pinch skin grafting is cost-effective, accelerates healing, and, following adequate training, may be performed by specialist nurses in the community. Simple venous surgery may be offered under local anaesthesia when only the superficial veins are incompetent; however, deep venous surgery has yet to prove itself in clinical practice. Implementation of dedicated community leg ulcer clinics using these research-based findings will result in a substantially reduced prevalence of venous leg ulceration.