North East Connected

Leg Ulcers in the NHS: An Unnecessary Problem

Nearly half a million adults in the UK experience a leg ulcer at any given time, or one in every 500 individuals throughout the region. Leg ulcers appear as an open wound that takes several months to heal on its own, causing pain and discomfort along with itching, swelling, and an unpleasant smell. Without proper treatment, leg ulcers can become infected and put a severe strain on an individual’s ability to walk or perform regular activities without a degree of pain.

Even though leg ulcers are fairly common, especially among those over the age of 80, there are thousands of adults who live with the negative effects of leg ulcers unnecessarily each year. That is because the NHS is quick to offer plans of treatment that only encouraging closing of the open sore. Instead of focusing attention on treating the underlying cause, doctors and nurses provide recommendations for months’ long compression bandaging. This leaves patients with leg ulcers prone to developing another wound down the line because the most common culprits for the health condition, venous reflux, and varicose veins, are not properly addressed.

The Problem with Compression

For several decades, compression therapy with bandages and dressing has been used as the primary treatment of leg ulcers. The issue with this treatment option is that it does not provide a long-term solution to the breakdown of veins that often cause leg ulcers in the first place. Due to a previous vein issue, like deep vein thrombosis, a knee or hip replacement surgery in the past, or hereditary links to vein disorders, the veins of the legs may fail over time. As this takes place, the blood that normally flows upward toward the heart ends up moving in the opposite direction. When blood flow is disrupted in this way, it pools in the legs causing bulging, twisted veins that do not perform properly. Varicose veins are the result, and ultimately, leg ulcers may take place after a bump or cut at or near the faulty veins.

Without focusing on treatment of the varicose veins within the leg, Eddie Chaloner, vein specialist with a vein clinic in the UK, explains that individuals have a greater chance of developing leg ulcers again in the future. Compression bandaging can be beneficial in healing the open wounds of leg ulcers, but it does little to solve the problem of broken vein walls within the legs. The NHS recommends compression therapy to patients with leg ulcers instead of advanced procedures for a variety of reasons, but this standard practice only perpetuates the cycle and leaves individuals susceptible to problems in the future.

Instead of focusing on the symptoms of an underlying vein issue by treatment through compression bandaging, adults with leg ulcers linked to venous disorders should be given the opportunity to undergo a minimally-invasive surgical procedure known as endovenous laser therapy (EVLT). Through this treatment method, a small IV is inserted into the affected vein, and laser heat is transmitted through a small incision to seal off the vein wall. When done accurately, EVLT allows the body to discard the malfunctioning vein, giving the healthy veins of the leg the ability to move blood as it was intended. EVLT take less than an hour to complete, is done under local anesthesia, and creates an outcome for patients that provides a long-term solution to the underlying issue leading to leg ulcers.

The unfortunate truth is that the NHS has been in a cost-saving mode for several years, and there is a widespread misconception that compression bandaging, or merely treating the symptoms of leg ulcers, is more cost-effective than a procedure like EVLT. Recent studies have shown that the surgery costs about the same as compression bandaging when the expenses associated with ongoing nursing care and the time to heal is factored into the mix. Compression therapy is also the suggested treatment for leg ulcers throughout the NHS because there is a glaring lack of training among specialists who are able to perform the EVLT procedure. Several NHS facilities do not offer EVLT in-house, and so the patient is left with compression as the only option for treating painful leg ulcers.

Over time, not giving patients the opportunity to undergo the brief surgical procedure opens the door for more long-term costs for the NHS correlated to the reoccurrence of ulcers and other complications with vein disorders.

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