Leg ulcers abate with surgery.

In patients with chronic venous leg ulcers, short-term outcomes are similar whether the patients undergo surgical correction of the underlying venous reflux or are managed more conservatively. But the recurrence rate 1 year later is much lower in those who have surgery, according to Dr. Jamie R. Barwell of Cheltenham (England) General Hospital and associates.

The investigators randomly assigned 500 patients to undergo either surgery plus multilayer compression bandaging or compression treatment alone. Most patients (60%) had isolated superficial venous reflux; 25% had mixed superficial and segmental deep venous reflux, and 15% had mixed superficial and total deep venous reflux, the investigators said (Lancet 363[9424]:1854-59, 2004).

Ulcer healing was similar between groups at 24 weeks, so the surgery did not enhance initial outcomes. However, recurrence rates 1 year later were much lower in the surgically treated group (12%) than in the compression-only group (28%). Surgery conferred this advantage in all patients, regardless of the type of venous reflux they had or the presence of comorbidities, such as diabetes.