Part 1 Epidemiology, service provision and health economics: introduction; the size of the problem; risk factors for ulceration; who carries out the care?; treatment times and healing rates; the financial cost of leg ulceration and venous disease; impact of leg ulcers on quality of life. Part 2 Causes of leg ulcers: introduction; venous ulcers - anatomy of the venous system and mechanics of blood flow, clinical signs of chronic venous hypertension, theories of the cause of venous ulcers; arterial ulcers; rheumatoid arthritis and vasculitic ulcers; diabetic ulcers - angiopathy in the diabetic patient, neuropathy in the diabetic patient, other causes of ulceration; more unusual cause of ulceration. Part 3 Patient assessment: introduction; assessing the immediate cause of the ulcer and any underlying pathology - clinical signs and symptoms, past medical history, some simple vascular assessment methods, other simple investigations, further vascular assessment methods, mixed aetiology ulcers; local wound assessment; other factors that may affect healing; appendix 3.1 - more specialist vascular assessment - a) arterial assessment, b) assessing the venous system. Part 4 Treatment options: priorities in leg ulcer management; management of venous ulcers - aims of management, characteristics of compression bandages, multilayer bandaging regimens, criteria for using reduced compression, applying the bandage, compression stockings, intermittent compression bandages, preventing and managing the recurrence of venous ulcers; management of arterial ulcers; management of mixed arterial ulcers; management of ulcers associated with rheumatoid arthritis; management of the diabetic foot; creating the optimum local environment for healing - introduction, cleansing the wound, wound dressing selection, ultrasound, skin grafting, looking to the future; wider issues - causes of delayed healing, restricted mobility, peripheal oedema, malnutrition, psychosocial issues. Part 5 Patient education: why educate patients; creating a therapeutic environment for learning; assessment; planning; implementation and evaluation. Part 6 Quality assurance: introduction; what is quality?; why adopt a quality approach; quality assurance and leg ulcer care; the way forward. Part 7 Providing service: introduction; the Riverside community leg ulcer care - assessing the problem, planning the service, implementation of the service, patient care, evaluating patient outcomes and cost effectiveness, evaluating the training programme for nurses.
