Venous leg ulceration Resources

When caring for people with venous leg ulceration, exudate management is commonly seen as one of the main challenges for clinicians. However, unfortunately, the reason for this wound-related symptom is often not identified or fully understood and therefore the clinical interventions necessary to address the problem are not implemented (Tickle, 2016). This results in people living with wounds that are failing to heal and producing a volume of exudate that has a significant impact on their quality of life (Cunha et al, 2017). Commonly, the words ‘leaky legs’ or ‘wet legs’ are documented in patient notes as the presenting problem — this is not a clinical diagnosis; it is a symptom of an underlying condition which more than likely is venous disease. Unless this is recognised and treated correctly, those ‘leaky legs’ will continue to be a problem and potentially could have a devastating impact on the patient. It is therefore important to have a good understanding of venous disease as well as the role that exudate plays in wound healing, from initial wounding, through the stages of healing, and when (and why) it becomes a problem.

Venous leg ulcers (VLUs) are known to place a significant burden on healthcare services, with unhealed ulcers costing 135% more than their healed counterparts over the course of a year (Guest et al, 2016). This is a consequence of unwarranted variation in care attributed to difficulties experienced by non-specialist clinicians caring for VLU in the community. VLU healing rates are relatively unknown, and national targets for healing do not yet exist, but there is evidence in the literature that specialist VLU services improve healing rates (Moffatt et al, 1992). Healogics is a specialist third party provider of VLU and lymphoedema services to the NHS, that takes a systematic approach to the assessment and management of these co-existing conditions. This paper presents the healing rates of 1015 people with VLU treated by Healogics for the full 65-month duration of an any qualified provider (AQP) contract. Healing rates of 86.14% were obtained in an average of 117 days in line with the published healing rates from other specialist leg ulcer services (Moffatt et al, 1992; Edwards et al, 2005). The healing rates reported in this paper demonstrate that a consistent, specialist approach to VLU management that is underpinned by best practice and national guidelines can help to achieve timely healing in the majority of patients, and can identify more complex patients for whom healing is not possible, enabling them to be placed on a maintenance pathway. The authors suggest that grading of VLUs according to complexity and data collection and analysis of healing rates could help to improve healing outcomes on a national level.

To effectively deal with complex wounds, the importance of oedema and that all oedemas are on a lymphoedema continuum needs to be understood. The efficiency of lymphatic drainage is paramount to oedema management and wound healing. Therefore, interventions to help prevent damage to lymphatic capillaries, and techniques to facilitate lymphatic drainage and lymphangiogenesis should be considered as part of wound management. This article highlights the importance of the lymphatic system in the treatment of leg ulceration and the emergence of a new ‘hybrid nurse’, who combines the specialisms of tissue viability and lymphoedema to improve patient outcomes, reduce waiting times, and improve efficiency within the NHS with the provision of a one-stop service.

To effectively deal with complex wounds, the importance of oedema and that all oedemas are on a lymphoedema continuum needs to be understood. The efficiency of lymphatic drainage is paramount to oedema management and wound healing. Therefore, interventions to help prevent damage to lymphatic capillaries, and techniques to facilitate lymphatic drainage and lymphangiogenesis should be considered as part of wound management. This article highlights the importance of the lymphatic system in the treatment of leg ulceration and the emergence of a new ‘hybrid nurse’, who combines the specialisms of tissue viability and lymphoedema to improve patient outcomes, reduce waiting times, and improve efficiency within the NHS with the provision of a one-stop service.

The use of compression hosiery is commonplace in the community. Traditionally, compression hosiery has been used to prevent leg ulceration, including prevention of the recurrence of leg ulcers and skin breakdown after ulcers have healed (Nelson and Bell-Syer, 2012).

People with leg ulceration are predominantly treated in a community setting either in their own home, a clinic or a general practice surgery. Access to high quality, effective care is vital for timely healing. This article will consider aspects of the National Health Service quality agenda and how these align to leg ulcer care using national venous leg ulcer guidelines as a framework. The purpose of this is to prompt both practitioners and managers to consider the current provision of leg ulcer care and how this might stand up to scrutiny from a quality perspective.

Irene Anderson reader in Learning and Teaching in Healthcare Practice, and Programme Tutor, Tissue Viability, University of Hertfordshire.

Article accepted for publication: May 2012

Carol Coley discusses the use of emollients in the management of skin conditions

Carol Coley MA, BSc (Hons), RN is a Skin Cancer Nurse Specialist, Dermatology Department, Portsmouth Hospitals NHS Trust

Article accepted for publication: January 2009

Martin Tadej, Anna Colbourn, Andy Kerr & Cathie Bree-Aslan discuss the management of non healing leg ulcers

Martin Tadej RGN, BBA is a Tissue Viability Nurse. Eastbourne Wound Healing Centre

Anna Colbourn RGN is a Tissue Viability Nurse. Eastbourne Wound Healing Centre

Andy Kerr RNDip HE is a Tissue Viability Nurse. Eastbourne Wound Healing Centre

Cathie Bree-Aslan RGN, DipN, RSHom, DipHerb is a Tissue Viability Nurse. Eastbourne Wound Healing Centre

For further information please visit www.activahealthcare.co.uk/phmb/