Venous leg ulcer recurrence: prevention and healing

Traffic light system for healed venous leg ulcer monitoring

The purpose of this paper is to introduce the conceptualisation and evolution of a trialed Doppler traffic light system for healed venous leg ulceration. This tool aims to facilitate clinical decision-making and provides a systematic approach to the ongoing assessment of arterial disease in patients with healed venous leg ulcers when used in conjunction with other purposely-designed assessment documentation to ensure the novice registered and unregistered nurse contributes safely and effectively to the care of patients. The validation and trial of this clinical decision tool is discussed in terms of the use of a recognised methodology determining its fitness for purpose and robustness.

Development of a pathway of care for venous leg ulcer management

During the implementation of a leg ulcer care pathway, it became apparent that training on this subject was often inaccessible and cursory. Additional education was provided, which included a competency assessment of all participants.

Recent insights into the causes of chronic leg ulceration in venous diseases and implications on other types of chronic wounds

Venous ulceration represents the most prevalent form of difficult-to-heal wounds and these problematic wounds require a significant amount of healthcare resources for their treatment. In order to develop effective treatment regimens a clearer understanding of the underlying pathological processes that lead to skin breakdown is required. However, to date, most of these studies have tended to focus on describing the pathology of already-established ulcers. By bringing together relevant aspects of diverse disciplines such as inflammation, cardiovascular, and connective tissue biology, we aim to provide an insight into how circulatory abnormalities that are caused by the underlying disease etiology can induce local tissue inflammation resulting in tissue breakdown. Initially this results in internal tissue damage but if the underlying disease is not treated, the internal tissue damage can worsen and lead to open ulceration. This article discusses the cause-and-effect relationships between chronic venous insufficiency and venous ulceration, focusing particularly on the biological processes that lead from the underlying disease condition to overt ulceration. Available evidence also suggests that formation of pressure, diabetic foot and arterial ulcers, and ulcers as results of blood disorders, is also likely to share some of the same biological processes as venous ulcers.

Preventing venous ulcer recurrence: a review

This review article examines the available evidence on both the primary and secondary prevention of venous ulceration, exploring both the individual, social and financial implications of system failures that allow patients to remain at increased risk of recurrent ulceration. The role of both venous disease assessment and corrective superficial venous surgery are discussed in the light of recently published randomised controlled studies on the role of superficial venous surgery as both an adjunct to ulcer healing and ulcer prevention.

Setting up a community nurse-led healed leg ulcer clinic

Chronic obstructive pulmonary disease (COPD) is a progressive, smoking-related, chronic disease that eventually impacts on every area of the lives of the patient and his/her family and carers. The nature of the disease - chronic, irreversible airflow obstruction - limits the impact of drug therapy, particularly as the disease progresses. Increasing breathlessness on exertion saps confidence, reduces self-esteem and produces dependence. In addition, frequent exacerbations utilize health service resources. Non-pharmacological approaches, such as pulmonary rehabilitation, together with lifestyle advice that enables patients to help themselves manage exacerbations, maintain independence and quality of life and make the most of life with COPD can benefit both patients and the health service.

The wearing of compression hosiery for leg problems other than leg ulcers

Many people have leg problems other than ulceration. Practitioners from one primary care trust in Suffolk considered nursing assessment of these patients and the fitting of prescribed compression hosiery where appropriate as a health promotion initiative. However, ongoing assessment adds to heavy clinical demands on community practitioners. Engaging with people to take greater responsibility for their health, and recognition that practice should be underpinned by credible evidence, provided the backdrop to a two-staged retrospective audit. Results are based on the nursing records of 101 patients wearing prescribed compression hosiery other than for previous venous ulceration. It was concluded that following an initial detailed holistic assessment, including ankle brachial pressure index, those patients who meet identified characteristics can be empowered to return for reassessment only if there is a change in their health status, or skin changes to their legs. An information leaflet is considered critical to this strategy.