Leg ulcers: epidemiology and aetiology.

In a regional Health District with a population of 198,900, 357 patients with 424 ulcerated legs were documented, an overall prevalence of 0.18 per cent. The prevalence of ulceration in the 92,100 aged greater than 40 years was 0.38 per cent. Fifty per cent of the lesions had been present for more than one year, and 62 per cent of patients had never attended any hospital. The patients were stratified by history of peripheral arterial disease. A random sample (100 patients, 193 legs) was examined by ultrasound and photoplethysmography to assess the venous and arterial circulation; 38 per cent had evidence of deep vein involvement and 43 per cent had superficial vein incompetence. An ischaemic element was present either in isolation (9 per cent) or combined with venous disease (22 per cent) in a total of 31 per cent, with a mean pressure index of 0.62 (s.d. 0.14). Simple objective methods of assessment together with dedicated community staff with ready access to specialized facilities can enhance the service provided to patients with leg ulcers.