Venous leg ulceration Resources

Venous leg ulcers (VLUs) present a huge burden, not just in terms of healthcare costs (Guest et al, 2017), but also in their negative impact on patient quality of life (Marczak et al, 2019). A holistic, multifaceted approach to assessment is needed to ensure that all factors contributing to their development are considered to allow optimal healing to take place. The European Wound Management Association (EWMA, 2016) however, has highlighted a disparity in care between community and specialist settings, with some nurses lacking the necessary skills needed to undertake effective assessment. Since wound assessment is a core component of wound management, impacting directly on therapeutic choices and thus healing (Lázaro-Martínez et al, 2018), it is imperative that general practice nurses (GPNs) are supported in being able to assess wounds accurately. This article discusses and reflects on the value of effectively assessing wounds in primary care using the Triangle of Wound Assessment framework, which focuses not just on the wound bed, but also the periwound skin.

The number of patients with venous leg ulcers is growing as the population ages. Recent estimates indicate that 730,000 people with venous leg ulcers were treated in 2012/13 (Guest et al, 2015); a number that is predicted to increase year on year. Venous leg ulcers can be difficult to manage in some patients despite best practice, particularly in those with multiple comorbidities. These patients can develop chronic ulceration that can be present for months or even years in some cases. The cost of managing these patients presents a significant burden to the NHS. An evaluation was carried out to determine the efficacy of LQD® wound spray, a unique spray-on wound dressing that contains Chitosan FH02™, in promoting wound healing in patients with longstanding venous leg ulcers. The results indicated that LQD wound spray contributed to putting the wounds onto a healing trajectory.

Long-term conditions: compression therapy and venous leg ulceration.

Compression therapy is the recommended treatment for the prevention and management of venous leg ulceration and lymphatic insufficiency (Scottish Intercollegiate Guidelines Network [SIGN], 2010; Harding et al, 2015; Wounds UK, 2016). Various methods of delivering compression are used in the UK, including bandaging, hosiery and Velcro® wraps. Selecting the correct device can be challenging for clinicians. This article explores the different compression systems available to help general practice nurses (GPNs) make appropriate choices for their patients, i.e. an option which is acceptable to the patient and can be applied safely and proficiently.

A considerable proportion of general practice nurse (GPN) visits are for patients with venous leg ulcers (Guest et al, 2015). However, clinicians’ skills and knowledge in managing these cases vary (Wounds UK, 2016), due to the increase in comorbidities and complexities of venous ulcer presentation (Newton, 2010). This article explores accurate venous leg ulcer assessment through analysing the best evidence available. Prevalence, as well as wound, holistic and Doppler assessment are covered to provide a detailed assessment plan that can be used to ensure evidence-based patient care. Management will not be discussed in detail, but appropriate techniques will be considered with compression therapy being referred to as the gold-standard treatment for venous ulceration (National Institute for Health and Care Excellence [NICE], 2016).

While multilayer compression bandaging has traditionally been seen as gold standard therapy for venous leg ulcers, success of treatment depends on the competency of the nurse applying the bandages and patient concordance (Scottish Intercollegiate Guidelines Network [SIGN], 2010). Furthermore, wearing compression is a lifelong commitment as, following healing, it is still needed to prevent ulcer recurrence and skin breakdown.

During this maintenance phase, compression hosiery is usually prescsrbed (Nelson and Bell-Syer, 2012). However, som patients also find it difficult to concord with compression hosiery  (Jull et al, 2004). juxtalite (medi UK) is an alternative maintenance system for those patients who cannot tolerate or apply compression garments.

Patients with lower limb ulceration are common in clinical practice, as between 0.6% and 3.6% of adults will develop a leg ulcer in their lifetime (Graham et al, 2003; Posnett and Franks, 2007). This equates to between 70,000 and 190,000 people in the United Kingdom having an active leg ulcer in any one day (Posnett and Franks, 2007).

The most common cause of lower limb ulceration is attributed to venous hypertension, and venous ulceration is reported to affect up to 1% of all adults (Christian, 2013). The management of venous ulceration is costly in terms of treatment costs, nursing time and patient suffering (Atkin, 2015).

This piece was sponsored by an educational grant from Activa Healthcare.