Management practices of Australian surgeons in the treatment of venous ulcers

Introduction:  Venous ulcers will affect 2% of the general population during the course of their lives causing significant morbidity. The aim of the present paper was to review assessment and treatment regimes used by surgeons throughout Australia and compare these with published guidelines. Methods:  A structured questionnaire was sent to all general and vascular surgeons in Australia. Questions detailing practice demographics, initial treatment, investigation and surgical intervention were asked. Responses were analysed using Fisher's exact test. Results:  A response rate of 36% was obtained from 1390 surgeons. This included 30% of the general surgeons and 67% of the vascular surgeons surveyed. Three hundred and seventy-one of these surgeons managed patients with venous ulcers. Vascular surgeons recorded ankle-brachial pressures (88%vs 55%; P < 0.0001) more frequently and used compression therapy more often than general surgeons (99%vs 61%; P < 0.0001). Superficial vein ablation was performed by 95% in the presence of superficial vein reflux and a normal deep system, 46% also performed this procedure in the setting of an incompetent deep system. Antibiotics were prescribed by 15% of surgeons with no evidence of infection. Conclusions:  Initially venous ulcers are well managed in Australia; however, antibiotics are overprescribed in their treatment. The current rate of compression therapy use is low for some groups of surgeons and should be improved. The failure to use compression in all cases of venous ulcers and the overprescription of antibiotics in the absence of cellulitis suggests that significant improvements can be made in the management of venous ulcers in Australia.