Commentary on "Changes in the aetiological spectrum of leg ulcers after a broad scale intervention in a defined geographical population in Sweden".

OBJECTIVE The study aims to compare the spectrum of leg ulcer aetiology in Skaraborg County in 1988 and 2002, an evaluation of 14 years of targeted leg ulcer intervention. DESIGN Cross-sectional study within the professional health-care system in Skaraborg County. MATERIALS In 2002, 621 leg ulcer patients were identified through a cross-sectional population survey. METHODS Half of the registered patients were randomly selected and offered clinical examination. A total of 198 patients with 246 legs underwent examination and were categorised in detail according to aetiology. Data were compared with the initial study in 1988. RESULTS Venous incompetence was present in 140 (57%) legs and the dominating cause in 94 (38%) of the leg ulcers, 40 (16%) due to deep venous incompetence. Arterial insufficiency was identified in 90 (37%) legs and the dominating aetiological factor in 41 legs (17%), eight (3%) being critical ischaemic ulcers. The relative risk (RR) of developing a leg ulcer in 2002 vs. 1988 was 0.77. The RR of a venous ulcer was reduced by 46%, arterial by 28%, while there was an increase in diabetic ulcers by 29% and multifactorial by 42%. CONCLUSION The aetiological spectrum of leg ulcers has changed, most likely due to a new management strategy in the care of leg ulcer patients.