ABSTRACT
Venous ulceration and the skin changes which precede ulceration are best managed by careful objective evaluation of the venous system of the lower limb followed by compression bandaging or stockings and surgical treatment where appropriate. Systemic drugs and topical applications are widely used in the management of leg ulceration but what should we use and when? Surgical intervention is appropriate where leg ulceration is attributable mainly to superficial venous incompetence alone in a patient fit enough for this procedure. In some studies, this would apply to as many as half the patients presenting with venous ulceration.1,2 A number of studies show that healing usually progresses well in such patients and recurrent ulceration is not a common problem.3 A relatively small proportion of patients are suitable for deep vein reconstructive procedures; many are excluded because of age and infirmity or medical unfitness for major surgery. In general, such patients are best managed by compression treatment alone. Unfortunately, whilst compression treatment can usually achieve healing if high enough levels of compression are used, recurrence is a common problem, with an annual recurrence rate of 25 percent per year.4 Perhaps drugs can speed healing or prevent recurrence? Many clinical studies have been published over the years. Examination of them is informative and revealing!
