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Compression in venous leg ulcers: a consensus document


Innovations in venous leg ulcer management


Compression hosiery can be used for primary prevention of venous complications following deep vein thrombosis or in patients with varicose veins, to prevent recurrence of leg ulcers following healing (and more recently to heal venous ulcers). When used for healing ulcers, it is important


to ensure that the correct pressure is applied using a combination of single, multiple layer or specifically designed two-layer hosiery kits to ensure the pressure is sufficient to achieve healing. Hosiery is available in UK and European/RAL classification with the European/RAL stockings providing a higher pressure profile that those from the UK. Evidence suggests that healing rates improve and recurrence rates reduce when RAL hosiery has been introduced as part of a comprehensive leg ulcer service[9]


. Clinicians


need to assess the ability of patients/carers to apply their hosiery to ensure effective management.


9 References


1. Cuddigan JE, Ayello EA. Clinical decision making for debriding


chronic wounds. World Council of Enterostomal Therapists Journal 2004; 24: 8.


2. Dowsett C. The role of the nurse in wound bed preparation. Nurs Stand 2002; 16: 69.


3. Schultz GS, Sibbald RG, Falanga V, Ayello EA, et al. Wound bed preparation: a


systematic approach to wound management. Wound Rep Regen 2003; 11: S1–28


4. EWMA. EWMA position document: wound bed preparation in


practice. 2004; MEP, London, UK.


5. Dowsett C, Claxton K. Reviewing the evidence for wound bed


preparation. J Wound Care 2006; 15: 439–42.


6. Hampton S. Some simple solutions to wound


debridement. Nurs Res Care 2011; 13: 378.


To access free


basic wound care education visit Wound Essentials...


online at: www.wounds-uk.com/wound-essentials 17 18 Wounds International Vol 3 | Issue 2 | ©Wounds International 2012


Venous surgery: As previously described, underlying superficial venous reflux is often


the primary cause of leg ulceration. If venous ulcers recur, patients should be assessed for the degree of venous reflux and should be considered for superficial venous surgery to prevent recurrence[6]


that surgery did not improve ulcer healing rates but did significantly reduce 12-month recurrence rates after healing. The ability of patients to wear their compression hosiery greatly affects recurrence rates, therefore, surgery may be a good alternative for this group of patients.


Practice development Top tips for managing venous leg ulcers 10


Quality of Life: Many patients with venous leg ulceration go through a


cycle of ulcer healing and recurrence, which can influence their quality of life. When managing a patient with venous leg ulcers it is important to explore quality of life issues that may be influencing this cycle and introduce measures to improve and sustain changes where possible. Consideration should be given to pain, both at the dressing change and throughout the day. The effects of leaking and odour from a


leg ulcer should also not be underestimated and increasing dressing changes and treating infection can make a difference to quality of life. Social isolation can also have a major impact on a person's life and an important part of managing leg ulceration should focus on the psychosocial aspects of living with a venous leg ulcer[10]


.


CONCLUSION Venous leg ulceration is a significant and complex problem for clinicians to manage, as well as having a potentially dramatic effect on patients' quality of life. Managing all of the holistic factors detailed in


. The SIGN guidelines show


section one will ensure the patient , the wound, the environment, the resources and the clinician's skills are all taken into account when managing patients with venous leg ulcers.


AUTHOR DETAILS Heather Newton is Consultant Nurse Tissue Viability, Royal Cornwall Hospitals NHS Trust Truro, UK


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