Assessment and management of leg ulcers in the community and an outpatient clinic.

Aim: To compare the assessment and treatment of leg ulcers seen in the community and subsequently reviewed in an outpatient clinic, to the New Zealand Guidelines.
Methods: An observational study including consecutive patients presenting to vascular surgery outpatients with at least one leg ulcer. Outcomes included the clinical descriptions of ulcers, use of an Ankle Brachial Index (ABI) test and compression therapy for mixed and venous ulcers.
Results: The study included seventy-six patients. Every ulcer had an adequate clinical description. An ABI investigation was carried out in 9.1% and 66.7% of the patients in the community and outpatient clinic, respectively. Among 31 patients with venous or mixed ulcers in the community, 7 (22.6%) were initiated on compression therapy, and 1 (3.2%) on compression bandaging. Following outpatient clinic appointments, 29 (76.3%) of the 38 patients diagnosed with venous or mixed ulcers were on compression therapy with 20 (52.6%) on compression bandaging.
Conclusion: There are low rates of ABI measurements and initiation of compression therapy for patients with leg ulcers in the Otago regional community. This may be due to low accessibility to expertise in ABI measurements delaying initiation of compression therapy. Innovations in facilitating ABI investigation in the community and promoting the use of compression therapy are indicated.