26
WOUND CARE TODAY
2014,Vol 1, No 1
as well as mental health problems,
such as anxiety and depression (Jones
et al, 2006b; Woo, 2010).
It is vital that clinicians do not
add to the patient’s pain and they
should handle the limb with care,
particularly at dressing change.
Compression can help to relieve
pain by lessening the pressure of
oedema as well as supporting the
limb. Where appropriate, the patient
should be prescribed analgesia.
PREVENTING RECURRENCE
The healing process of a leg ulcer
can be lengthy and recurrence rates
are high — one study found that
after two years of compression
bandaging, up to 20% of venous leg
ulcers were still not entirely healed
(Rippon et al, 2007).
Continued follow-up from
clinicians and encouraging patients
to attend leg ulcer clinics can help to
maintain healthy legs. In addition,
the recent Venus trial has found
that recurrence is reduced if hosiery
is used once healing has occurred
(Ashby et al, 2013).
CONCLUSION
Management of venous leg ulcers
is an ongoing challenge for all
healthcare professionals, and with
life expectancy increasing the
propensity for ulceration grows.
Clinicians are responsible for the
care that they provide, and should
give due consideration for both its
clinical and cost-effectiveness.
The majority of leg ulcer
management is undertaken in a
primary care setting, either in GP
surgeries, specific clinics or leg clubs.
To achieve the best outcomes,
patients must be fully informed
of the underlying cause of the
ulceration and the reason for the
treatment offered. Healthcare
professionals should not manage in
isolation, but engage and work with
the multidisciplinary team with the
patient firmly at the centre of all
decisions relating to care.
WCT
REFERENCES
Ashby R, Gabe R, Shehzad A, et al (2013)
Lancet
383(9920):
871–9
Briggs M, Nelson EA (2010) Topical agents
or dressings for pain in venous leg
ulcers. Cochrane Database Syst Rev
2010 April 14; 4: CD001177
Cullum N, Nelson EA, Fletcher AQ,
Sheldon TA (2006) Compression for
venous leg ulcers. Cochrane Database
Syst Rev 3: CD001103
DouglasV (2001)
J Wound Care
10(9):
355–60
Dowsett C (2011)
Wounds UK
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EWMA (2002) Pain at wound dressing
changes. MEP, London
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Wounds
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318–23. Available
online at:
/
files/wounds/pdfs/Morton%20and%20
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FalangaV (2004) Wound bed preparation:
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Document:
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practice
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Franks PJ, Moffatt CJ (2001)
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(2006a)
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Lindsay E (2007)
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›
Wound facts...
concordance
Methods to improve concordance
with compression therapy include:
›
Develop a rapport with
the patient.
›
Be open about what having
a leg ulcer means and the
disease process.
›
Back up any verbal
information with leaflets,
hand-outs, etc.
›
Encourage patients to take
responsibility for their
treatment, involving them in
a Ô
contract of careÕ
and being
specific about what you expect
from them, as well as what
they can expect from you.
›
Outline the range of treatment
choices, rather than simply
presenting one option.
›
As well as lifestyle factors
and how active a patient is,
also consider any cultural/
religious influences when
choosing compression
therapy.
›
Be sure to recognise the
patientÕ
s pain and have a
strategy to relieve it.
Ravaghi H, Flemming K, Cullum N, et al
(2006) Cochrane Datbase Systematic
Review 19(2): CD002933
Rippon M, Davies P, White R, Bosanquet
N (2007)
Wounds UK
3(2):
58–69
RCN (2006)
The Nursing Management
of Patients with Venous Leg Ulcers,
Recommendations: clinical practice
guidelines
. RCN Publishing, London
SIGN (2010)
SIGN Guidelines 120.
Management of chronic venous leg
ulcers
. SIGN, Edinburgh (last modified
3/09/10)
Snyder RJ (2006)
Ostomy Wound
Management
52(9):
58–68
Stephen Haynes J (2010)
J Wound Care
19(9):
308, 382, 384
Stevens H (2006)
Br J Community Nurs
11(12 Suppl):
S27–S30
Timmons J, Bianchi J (2008)
Wounds UK
4(3):
59–71
Woo K (2010)
Wounds UK
6(4):
92–8
Top tip:
With current evidence and the
product choice available, using
four-layer bandaging for everyone
is not acceptable, as other options
can be found that do not decrease
efficacy and might be more
acceptable to a patient’s lifestyle.
FOCUS ON VENOUS LEG ULCERS
›
