A pilot leg ulcer clinic in a geriatric day hospital

Twenty-six patients with leg ulcers with a mean age of 80 years were assessed at a day hospital to determine the aetiology and to carry out a trial of four-layer compression bandaging for those suitable. Ten had ankle brachial pressure indices (ABIs) < 0.8. Of nine patients with venous disease who received compression bandaging, only two ulcers healed and have remained healed with fitted below-knee elastic stockings. The remaining patients were unable to tolerate compression or developed deterioration of their ulcers. Nine patients had unhealing arterial ulcers all unsuitable for reconstructive surgery. Five patients presented with pressure sores due to bandages, shoes or heel pressure in bed. All healed slowly with leg elevation and pressure relief. Four patients had extensive non-venous, non-arterial ulceration associated with fluid retention and dependent oedema exacerbated by spending their nights in chairs. Varicose eczema was healed in 12 patients. All the patients had multiple pathology and poorly controlled pain. Although complete 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.