Wound Care Resources

In each issue we investigate a hot topic currently affecting you and your community practice.

Awareness of the incidence of chronic oedema in the UK, and the consequences of inadequate management has grown over the last 10 years. Moffatt et al (2019) identified that over 50% of patients cared for by community nurses had an element of chronic oedema. A failure to identify and manage chronic oedema can result in the disease progressing to more advanced stages, which are more costly for patients and healthcare services to manage (Wound Care People, 2019). This article tells the story of Anne and her journey with chronic oedema. Her story exposes many inadequacies ranging from prevention to diagnosis, management, and prevention of harm. These culminated in a hospital admission and lengthy rehabilitation calculated to have cost in the region of £35,000. The use of an evidence-based care pathway is advocated and the potential impact which its use might have had for Anne at a number stages in her journey are explored. The combination of Anne’s story, and the financial analysis of the outcome and other potential outcomes had a care pathway been followed, make a powerful argument for change.

Surgical site infections (SSIs) are of serious concern for clinicians, patients and healthcare institutions worldwide. This study evaluated a new wound management pathway using Leukomed® Sorbact® (Essity) post-operative wound dressings in women with raised body mass index (BMI) undergoing lower uterine segment caesarean section (LUSCS) in the NHS Wrightington Wigan and Leigh Foundation Trust. Previous practice indicated use of a standard postoperative dressing for women with a BMI <35 and PICO™ single-use negative pressure wound therapy (NPWT) dressing for women with a BMI >35, following surgery. The new wound management pathway indicated that Leukomed Sorbact was suitable for women with a BMI ≥30–<50, gestational diabetes mellitus (GDM) or previous caesarean section with complications; NPWT dressings continued to be used for women with BMI ≥50, type 1 diabetes, previous numerous caesarean sections or at high risk of infection. Questionnaires were devised and disseminated for clinician and patient groups in relation to dressing use and patient satisfaction with the dressing.

Lower limb haematomas caused by trauma are debilitating wounds for the elderly who are most at risk. Prompt action needs to be taken to stop the bleeding and reduce the extent of tissue damage and skin loss. Literature on the management of lower leg haematoma is sparse compared to the management of skin tears, and there may be debate regarding surgical versus conservative approach. Many patients are not suitable for surgery due to underlying comorbidities, frailty and anaesthetic risk. Conservative management should support early evacuation of the haematoma and application of compression bandaging, avoiding lengthy hospital stays and enabling patients to be managed in the community setting.

Increasing pressures experienced within community nursing are having detrimental effects on the care and treatment provided to patients. Among these is the management of venous leg ulcers, where a culture of passivity has possibly developed, resulting in significant delays in measuring patients’ ankle brachial pressure index (ABPI) and reduction in the use of full, therapeutic compression therapy. As pressures increase, so does the financial burden on the NHS and associated psychosocial impact often experienced by patients living with lower limb ulcers. Urgent reform of leg ulcer services is required to better manage these conditions and improve the quality of care received by patients. This article provides evidence from examples of successful service transformation, and puts forward recommendations for future practice.