A PILOT LEG ULCER CLINIC IN A GERIATRIC DAY HOSPITAL

Twenty-six patients with leg ulcers with a mean age of 80 years were a ssessed at a day hospital to determine the aetiology and to carry out a trial of four-layer compression bandaging for those suitable. Ten ha d ankle brachial pressure indices (ABIs) < 0.8. Of nine patients with venous disease who received compression bandaging, only two ulcers hea led and have remained healed with fitted below-knee elastic stockings. The remaining patients were unable to tolerate compression or develop ed deterioriation of their ulcers. Nine patients had unhealing arteria l ulcers all unsuitable for reconstructive surgery. Five patients pres ented with pressure sores due to bandages, shoes or heel pressure in b ed. All healed slowly with leg elevation and pressure relief. Four pat ients had extensive non-venous, non-arterial ulceration associated wit h fluid retention and dependent oedema exacerbated by spending their n ights in chairs. Varicose eczema was healed in 12 patients. All the pa tients had multiple pathology and poorly controlled pain. Although com plete healing was achieved in only six patients, the importance of ABI measurement and the gross mixed pathology suggests that every elderly patient with a leg ulcer needs medical assessment and management and that this could form a valuable service of a geriatric day hospital.