NHS Patients with Leg Ulcers Suffering for Months with Inadequate Treatment
Leg ulcers are not a health condition any adult wants to experience given the pain and discomfort that comes along with it. As an open sore on the leg, typically above the ankle, a leg ulcer fails to heal in a short period of time, leaving individuals suffering for months at a time. Ulcers on the leg may cause itching or burning, emit a foul smell, or leak fluids until they are fully healed. Individuals with the condition may also experience swelling of the ankles and legs which makes it difficult to move or walk.
In older populations, one in 50 individuals in the UK is likely to experience a leg ulcer if they are over the age of 80, with one in 500 among people in other age groups experiencing the same issue once or more during a lifetime. A significant portion of leg ulcers is the cause of a persistent vein issue, like venous reflux or varicose veins, combined with an injury to the leg. Although treatment of the underlying vein problem can help keep leg ulcers at bay, there is a notable disconnect between how the NHS views and treats leg ulcers in patients who come to them for help.
Failing Patients with Ineffective Treatments
Over a century ago, leg ulcers were commonly treated with the help of compression bandaging – a method of placing tight bandages on the affected area in an effort to boost blood flow and circulation, ultimately healing the open wound. For some patients, compression bandaging promotes healing but only after several months of wearing the bandages, and the treatment only manages the symptoms of the underlying vein issue. In today’s medical environment, compression is still as widely used as it was 100 years ago, despite the fact that there are more appropriate, effective treatment options available to individuals with leg ulcers caused by vein disorders.
Eddie Chaloner, vein specialist with a private vein clinic in the UK, shares that while compression bandaging can be beneficial in healing leg ulcers caused by venous reflux or varicose veins, the solution is only temporary. He states, “Compression therapy is insufficient to heal venous leg ulcers in a timely manner, and while there is a 90 percent chance of closing the wound, patients typically need surgery after the fact to keep leg ulcers from returning.” The vein disorder in play must be treated in order to stop leg ulcers from reappearing, and compression therapy simply does not cut it.
One of the methods used to surgically treat broken down veins that often lead to leg ulcers is endovenous laser therapy, also known as EVLT. As a minimally-invasive procedure, EVLT is a 40-minute operation done under local anesthesia that utilises laser heat to seal off broken veins. Over time, the vein is absorbed by the body, and the healthy, functioning veins around the treatment area work to promote the normal blood flow from the legs to the heart.
Sealing off a broken vein through this simple procedure corrects the underlying issue leading to many leg ulcers, but the NHS is more focused on temporarily treating the symptoms through compression bandaging despite the clear long-term effects of EVLT. Chaloner explains that the NHS offers compression therapy as the solution to leg ulcers for a myriad of reasons, including the reality that many vascular surgeons in the health system are lacking up-to-date skills and training for the latest EVLT treatments. Additionally, patients are unaware that the procedure is an option for treating vein disorders, and doctors are quick to tell them a leg ulcer is not eligible for surgery like EVLT. Individuals end up taking what their provider says at face value simply to get quick relief from the painful effects of their leg ulcer. Unfortunately, compression therapy is a months’ long process and can be difficult to tolerate day in and day out.
Another factor in missing the mark with offering EVLT to patients with venous leg ulcers is the reality that many facilities within the NHS do not offer the procedure at all, or when it is offered, the technique used is not the most relevant or effect for today’s patients. Having a patchy framework of treatment options for vein disorders that lead to leg ulcers leaves patients suffering unnecessarily until the underlying issue is resolved.
The NHS is programmed to reduce costs in patient care across the board, and this trickles down to individuals living with leg ulcers and the conditions that cause them. Compression bandaging is thought to be a lower-cost option for these patients, but recent studies who that the expense associated with EVLT procedures is less over time than ongoing compression therapy. The cost for nursing care, changing dressings, and complications with slow-healing wounds add up to put a substantial strain on NHS pockets. Shifting to a more effective treatment like EVLT as the standard of care for venous leg ulcers is a far more viable strategy for the NHS, and a better long-term solution for its patients.