OBJECTIVES: The aim of the study was to investigate resource use and type of local wound treatment in patients with venous leg ulcers (VLU) in Sweden and to estimate the annual costs for leg ulcer patients. METHODS: Weekly resource use data for local wound treatment and details of surgical procedures were collected from a clinical survey (138 patients) in specialist care, primary health care, and home health care. Annual costs were calculated from the weekly resource usage multiplied by unit costs and published epidemiological prevalence data for Sweden. RESULTS: Frequency of dressing changes was 2.7 per week and compression was used in 93 % of the patients. Most dressing changes were performed in the patients home (66 %) and about 80 % of all dressing changes were performed by nurses or auxiliary nurses in primary health care or home health care. Surgical procedures (pinch graft, skin grafting, venous vascular surgery) had been undertaken in 22 % of the patients. The average weekly cost was €114, though it differed depending by ulcer size. For ulcers < 10 cm2 the weekly cost was €73, while the cost for larger ulcers was €179. The total direct annual costs for leg ulcers in Sweden could be estimated at €180 million (2002 prices) based on a point prevalence of 0.3 %. CONCLUSIONS: Treatment of leg ulcers seems to have improved compared with previous reports, resulting in slightly decreased costs. Nevertheless, the costs are still substantial and the management of these patients requires large resources. Further development including a more structured management, more careful selection of dressing products and decreased frequency of dressing changes could be encouraged. Such changes could imply further improvements in wound healing and quality of life for patients and decreased costs for the health care system and for society.