OBJECTIVES: Evaluation of quality of care of leg ulcers in the area of Hamburg, assessment of treatment with respect to guidelines, recording of patients’ quality of life and burden of treatment in the area of this community. METHODS: Potential criteria for the evaluation of quality of care were derived from the German AWMF-guideline and relevant international guidance. Wound experts (physicians and nurses) derived 20 priority criteria and indicators which define “optimal treatment” in a national Delphi consensus. A total score for quality of care was developed, ranging from 0-100 (no to perfect quality of care). Then, a representative sample of n= 520 patients with chronic leg ulcers of any origin was consecutively drawn. Patients were approached in wound clinics, office-based practices, nursing homes, home care services and special centres for homeless and drug addicts, thus including a large spectrum of 220 health care providers. All patients were interviewed, all wounds photographed and examined by trained wound experts. Patients were asked to fill a questionnaire addressing quality of life, prior therapy and health services/care. RESULTS: Data of 502 patients were analysed, including leg ulcers with venous (63%), mixed (23%), vasculitic (2%) and other (12%) pathogenesis. A high proportion of patients (78.6%) were treated with modern wound dressings. Pain and compression therapy was mainly in accordance with guidelines. However, deficits were detected for diagnostics (e.g. angiology, biopsies, pain measurement) and concomitant wound treatments. A high proportion of patients still had a markedly impaired quality of life. The mean total score for quality of care was below 60. CONCLUSIONS: In spite of mostly “lege artis” topical treatment, many patients in North Germany are not treated in accordance to relevant guidelines. The quality of care scoring method developed was shown to be a sensitive tool for health services research and evaluation.