Venous leg ulcers (VLUs) are the most common type of leg ulcer, accounting for over 90% of all leg ulcers. VLUs often develop after a minor injury to an area of the leg where persistently high blood pressure in the veins has already damaged the skin. Affecting an estimated 1 in 500 people in the UK, VLUs become more common with increasing age and approximately 1 in 50 people older than 80 years are estimated to have a VLU (NHS Choices, 2014). They are more common in people with varicose veins and in those with poor mobility, such as people with paralysis, osteoarthritis, leg fractures, and those who are obese or have had recent leg operations such as a hip or knee replacement. About 200,000 people in the UK have an open leg ulcer at any time (Posnett and Franks 2008).
One study estimated that 50% of venous ulcers did not heal within 9 months, 20% were unhealed after 2 years and 8% were still open at 5 years (Douglas 1995). With good management most VLUs will heal within 3–4 months, but the rate of recurrence is high. Some VLUs do not heal for many years and a small number never heal. Chronic wounds, such as VLUs, are often painful and up to 65% of people with a leg ulcer have severe or continuous pain (Briggs 2012), which can be worsened by wound dressing changes. Chronic wounds can cause reduced mobility, sleep loss, and wound odour and exudate. These all have a highly adverse effect on quality of life, often leading to social isolation and reduced work productivity (Persoon et al. 2004; Vowden and Vowden 2009).
VLUs are a significant cost and resource issue for the NHS. Ashby (2014) estimated a mean annual cost of £1795.30 per patient with a VLU treated with compression bandages, and £1492.90 per patient treated with compression hosiery, including health care consultation costs.