Leg ulceration is a chronic health condition that is often complicated by other co-existing conditions such as poor circulation. Approximately 20% to 30% of individuals with legs ulcers have evidence of mild to moderate circulation problems and the number continues to increase due to an aging population and high prevalence of diabetes. Existing guidelines endorse the need to reduce the strength of compression for the management of mixed venous arterial ulcers. However, consensus is lacking in the type of modified compression that is most appropriate for the varying degree of circulation compromise (ankle brachial index [ABI] between 0.5 and 0.8). To date, there is no randomized controlled trial that evaluates the efficacy of compression therapy for the treatment and management of mixed leg ulcers.
In the recent poll on this website, 95% of the voters agreed that we need a practice document to provide guidance and standardize care for mixed leg ulcers. We also completed a survey of more than 400 clinicians focusing on the knowledge, attitude, and practice in this patient population. Of interest, 84% of the clinicians agreed that compression should be considered for the care of mixed leg ulcers, but 56% indicated that compression should not be used if ABI is less than 0.8. There seems to be some inconsistency in how mixed leg ulcers are defined and whether compression should be used. More than 75% of the respondents agreed that most clinicians do not have the knowledge to manage mixed venous arterial leg ulcers. In summary, there is a pressing need to generate different levels of evidence to address this growing clinical issue to ensure patient safety and cost-effective care.