Diagnosis, assessment and management of mixed aetiology ulcers using reduced compression

Modified compression therapy in mixed arterial-venous leg ulcers: An integrative review

Leg ulcers remain an increased burden to healthcare cost and morbidity in modern society. While most leg ulcers are venous in origin, recognition and prompt identification of concomitant arterial occlusive disease is critical to determine underlying aetiology and subsequent management. This integrative review presents the current evidence to establish the role of modified compression therapy (MCT) in treatment of mixed arterial venous leg ulcers (MAVLU). A literature search was conducted using the electronic databases CINAHL, MEDLINE, PUBMED, and Embase. Ten studies met the eligibility criteria and were subsequently analysed. Our review concludes that MCT, with compression pressures between 20 and 30 mmHg, can promote healing in MAVLU with moderate arterial insufficiency (0.5 ≤ ABPI ≤0.8). If ABPI is <0.5, MCT can be considered once restoration of acceptable ABPI is achieved. Intolerance, lack of response or further deterioration of disease within 3 months should prompt further arterial imaging and intervention. MCT is generally well tolerated with no adverse outcomes reported. A holistic yet individualised approach is vital in order to account for all factors influencing this patient-led decision-making process, ultimately ensuring effective treatment, which improves patient's quality of life and reduces socioeconomic burden of the disease.

An introduction and guide to effective Doppler assessment

Accurate and timely diagnosis of leg ulceration is an essential factor in making evidence-based, effective decisions regarding patient management with the aim of swift wound healing and/or referral to the appropriate specialty. Nurses are professionally responsible for ensuring that patients receive the appropriate assessment and evidence-based management. This article examines the most up-to-date guidance on Doppler ultrasound as a key element of this assessment. Approaches to assessment will be explored, with emphasis on the need to include a Doppler ultrasound as one key element of a larger, holistic assessment. An introduction to the ankle-brachial pressure index (ABPI) will be given, followed by a step-by-step guide to standard procedures for carrying out a full Doppler ultrasound. Alternative options for measuring ABPI are also provided.

Reviewing the evidence for wound bed preparation

This paper explores the nature of evidence and how it has evolved in recent years, and sets out a process for assembling and assessing the evidence to support wound bed preparation as an effective method of managing chronic wounds

Doppler ultrasound--basics revisited

Palpation of pedal pulses alone is known to be an unreliable indicator for the presence of arterial disease. Using portable Doppler ultrasound to measure the resting ankle brachial pressure index is superior to palpation of peripheral pulses as an assessment of the adequacy pf the arterial supply in the lower limb. Revisiting basics, this article aims to aid the clinician to understand and perform hand-held Doppler ultrasound effectively while involving the client or patient in the process. The author describes the basics of Doppler ultrasound, how to select correct equipment for the process, and interpretation of results to further enhance clinicians' knowledge.