Practice development Innovationso... Author: Heather Newton


How to... Top tips for managing venous leg ulcers


A 1 References


1. NHS Centre for Reviews and Dissemination. Compression therapy for venous leg ulcers.


Effective Health Care 1997; 3(4): 1–12.


2. Kistner RL. Emerging treatment options for venous ulceration in


today’s wound care practice. 2010; Ostomy Wound Manage 56: 3–4.


3. Vowden P, Apelqvist J, Moffatt C. EWMA Position Document. Hard-to- heal wounds: a holistic approach. 2008; MEP, London.


4. RCN. Clinical Practice Guidelines. 2006; RCN, London.


5. Stephen-Haynes J. How to… Top ten tips for Doppler ABPI.Wounds International 2011; 2(4).


6. Scottish Intercollegiate Guidelines Network (SIGN).


Management of Chronic Venous Leg Ulcers. A National Clinical Guideline. 2010; SIGN, Edinburgh.


Figure 1. Deep venous leg ulcer.


leg ulcer is defined as a loss of skin below the knee, which takes more than six weeks to heal[1]


[Fig 1]. Venous leg


ulcers are caused by sustained high pressure within the venous system of the leg. Over half are caused by progressive venous reflux that begins as varicose veins, and the remainder develop after a deep vein thrombosis[2]


. The


key to effective management is accurate assessment of risk factors to enable the appropriate diagnosis to be made and the use of compression therapy to reduce the venous hypertension. In order to achieve this there are a number of important factors to consider.


Holistic management: When managing venous leg ulcers, a holistic approach should be taken. This ensures that all relevant factors are taken into account. Vowden et al[3]


identified five key factors that should be


considered in relation to the progression of healing: 1: Wound-related factors 2. Patient-related factors


3. Skills and knowledge of the healthcare professionals


4. Resources and treatment-related factors 5. Environmental factors.


ulcer, the UK Royal College of Nursing (RCN) guidelines[4]


2


Assessment of risk factors: For any patient that presents with a new or recurring leg


suggest that a full clinical history


together with a physical examination is conducted. It is important to use a structured assessment tool based on the risk factors identified. Family history of venous disease or history of varicose veins or deep vein thrombosis can increase the risk of developing venous ulcers. Any history of phlebitis, trauma or surgery, which may have damaged the veins, also increases the risk as can prolonged standing, obesity and multiple pregnancies. Robust risk assessment can lead to a more accurate diagnosis, which, in turn, supports effective management.


3


Skin assessment: Skin changes are often found on the lower leg as a result of a rise


in venous pressure over a prolonged period of time [Fig 2]. These skin changes aid diagnosis and lead to appropriate management. Brown/ pink pigmentation can be caused by leakage of red blood cells and deposits of haemosiderin. The skin can become very dry and itchy and, as the pressure rises, more leakage of waste products from the veins occurs, resulting in an eczematous reaction known as gravitational eczema. The tissue around the gaitor area can become thickened as fibrous tissue is deposited in the dermis and fatty layers of the skin. The leg shape subsequently changes appearance and over time can take on the look of an inverted champagne bottle.


4 15 16 Wounds International Vol 2 | Issue 2 | ©W ol 3 | Issue 2 | ©Wounds International 2011 tional 2012


Vascular assessment: A thorough patient and skin assessment can lead the


practitioner to a venous ulcer diagnosis, however, it is important that a Doppler assessment or Duplex scan is performed prior to the application of compression bandaging or hosiery to exclude the


Practice development Top tiHposw t for managing venous leg ulcers


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