Poor calf muscle pump function in patients with chronic venous ulceration can be improved by physical exercise.

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This study has shown that evaluations of calf pump function and venous reflux using APG display variations in repeated measurements and in the test-retest measures. The variations found within patients and on retesting patients on different days suggest that APG is very unlikely to be able to detect small changes in the parameters of venous reflux and calf pump function. It is essential to understand the inherent variation of APG measurements when they are used to assess treatments that are designed to improve venous function.

Objective To evaluate the frequency of malignant ulcers in patients presenting with leg ulcers. Design A descriptive study from data collected between July 1988 and June 1995 from 981 patients (2448 ulcers) attending a leg ulcer clinic. Setting A specialised leg ulcer clinic at a tertiary teaching hospital. Subjects 43 patients with 55 malignant skin lesions. Outcome measures Tissue biopsies in ulcerated lesions that suggested malignancy or were not responding to appropriate treatment. Results Forty‐three patients were found to have malignant lesions on the legs, giving a frequency of malignant ulcers of 4.4 per 100 leg ulcer patients, or 2.2 per 100 leg ulcers. Seventy‐five per cent of the malignant ulcers were basal cell carcinoma and 25% were squamous cell carcinoma. Conclusions Malignant skin changes are common in chronic leg ulcers. A biopsy should be taken from all suspicious ulcers or ulcers that do not respond to appropriate treatment.

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Objective: To assess the effect of elastic stockings on reducing the area of lipodermatosclerosis in patients with healed venous ulceration. Design: Patients in this study were part of a randomised controlled trial to assess elastic stockings in preventing venous ulcer recurrence. Setting: Leg ulcer clinic at a tertiary teaching hospital. Patients: Consecutive consenting patients with leg ulcers due to venous disease alone, that had healed 2 weeks previously. Interventions: Patients were randomised to below-knee graduated compression stockings (Venosan 2003) or no stockings. Main outcome measures: Patients had the area of lipodermatosclerosis measured on admission to the study and at 6-monthly intervals. Time to ulcer recurrence was also recorded for a 2-year follow-up period. Results: One hundred and fifty-three patients were randomised to the main study (stockings 72, no stockings 81); 52 had re-ulcerated by 6 months (15 stockings, 37 no stockings). Lipodermatosclerosis was significantly reduced after 6 and 12 months in those patients wearing stockings but not in the control group (repeat measures ANOVA p = 0.01, p = 0.04). The initial area of lipodermatosclerosis was significantly larger in those patients who re-ulcerated within 2 years of entering the study compared with those who did not re-ulcerate (re-ulceration, 293 cm2; no re-ulceration, 50 cm2). Conclusions: Elastic stockings alone can improve the skin changes of lipodermatosclerosis and lower the rate of ulcer recurrence.

Objective: To evaluate the influence of minimal-stretch and elasticated bandages on calf muscle pump function in patients with chronic venous disease. Design: An open, randomised, crossover study. Setting: University Department of Surgery, Fremantle Hospital, Perth, Australia. Subjects: Twenty patients with chronic venous disease and recently healed chronic venous ulcers. Method: Five different bandaging regimens were applied on each patient, and calf muscle pump function was assessed by using air plethysmography. Results: There was no significant difference in the venous filling index (VFI) and ejection fraction (EF) between the five different bandage regimens, and also no significant difference in four of the five bandage regimens over a 7-day period ( p>0.05). However, the VFI was significantly reduced and the EF was not significantly altered after the application of both elasticated and minimal-stretch bandages ( p<0.05, = p>0.05 respectively). Conclusion: All the bandage regimens used in this study have a similar influence on calf muscle pump function, and may therefore have a similar effect on the healing of chronic venous ulcers.