A modern leg ulcer service

Aim: To define the components and organization of a modern leg ulcer servic e that is acceptable to patients, cost effective and produces high quality outcomes. Method: Analysis of data from published literature as well as experience fr om the organisation of a leg ulcer service in Gloucestershire. Synthesis: Assessment of leg ulcers requires the services of a vascular lab oratory to assess the venous and arterial systems. Effective systems of com pression must be employed. Staff and patients must be educated to understan d the principals behind their use. For some patients pinch-grafting may be appropriate. Where arterial disease is present in the lower limb, reconstru ctive surgery should be used for the lower limb vessels. The organisation o f such a service must ensure good liaison between General Practitioners, co mmunity nurses and hospital specialists. Many patients may be managed in co mmunity leg ulcer clinics. In some cases, the advice of specialists such as rheumatologists and dermatologists may be required. Conclusions: A national framework for leg ulcer management is needed within which resources are made available in a way that satisfy local needs. Such a framework must be based on management protocols derived from evidence-ba sed practices that have been developed through the experiences of modern le g ulcer services.