Leg ulcer Resources

Lower limb ulcers are one of the most common chronic wounds in the UK and have a negative impact on health-related quality of life (Phillips et al, 2020). Venous leg ulcers (VLUs) often present with excessive exudate, which may damage the wound bed and
periwound skin; and therefore act as a barrier to wound healing. Cleaning and debridement are key to the management of devitalised tissue and exudate. Although debridement helps promote the healing of both arterial and venous leg ulcers, its use may be restricted by pain levels associated with the procedure (Claeys et al, 2011). Because pain can be a barrier to patients tolerating debridement, this may compromise the healing process (Roberts et al, 2019). A small-scale evaluation was recently completed to investigate the efficacy of wound debridement pads, together with patient perceptions of the treatment. The impact on pain and tolerance of pain during the use of
pads was explored. Spending time explaining the potential benefits of debridement on wound healing and listening to patient concerns appeared to have a positive impact on acceptance of treatment.

A leg ulcer can be defined as a break in a person’s skin which becomes chronic in nature and takes longer than two weeks to heal (NHS UK, 2019). Evidence outlined by The National Institute for Health and Care Excellence (NICE) states that the prevalence of leg ulcers in the United Kingdom is around one percent over a lifetime, which still describes a large number of people (NICE 2022; Lim et al, 2018). The prevalence of leg ulcers continues to rise and a shift in lifestyle factors, including smoking and obesity, have contributed to this (Agale, 2013). Further risk factors for developing leg ulcers include immobility, advancing age, a history of varicose veins or deep vein thrombosis (DVT) and having a sedentary lifestyle (Scottish Intercollegiate Guidelines Network [SIGN], 2010; Lim et al, 2018). The challenge of caring for these chronic wounds often falls to staff in primary care. Therefore, they should have a good understanding of leg ulcers and how best to treat them. In the author’s opinion, Leg Clubs® provide an ideal opportunity to manage lower limb wounds, while also tackling the wider holistic issues of leg ulcers, such as social isolation and loneliness.

With an ageing population, it is likely that the numbers of leg ulcers requiring intervention will increase proportionately. Given that most leg ulcer care is conducted in the community, this will place an extra burden on primary care staff. Therefore, any cost-effective interventions which improve management are worth considering. The Complex Wound Clinic team (Central and North West London NHS Foundation Trust) undertook a 12-month evaluation of using octenidine-based antimicrobial wash mitts as an alternative to
bucket washing. The aim was to monitor both patient and staff reaction to the use of wash mitts instead of bucket washing, track reported incidents of staff musculoskeletal injuries, and monitor infection rates, including Pseudomonas and wound infections requiring antibiotics.

In each issue of JCN we ask a clinical expert to take a look at a therapy area and examine some everyday problems that community nurses may experience. In this issue, we look at venous leg ulceration and associated oedema and ask the question...

How do I reduce foot oedema while healing a leg ulcer?

Leg ulcers and chronic oedema can be complicated to treat, particularly when oedema is present in the the foot and you are trying to apply compression bandaging. We asked Winnie Furlong, the clinical lead for the leg ulcer service, The Princess Alexandra Hospital and West Essex Leg Ulcer Service, to explain the best way to treat venous leg ulceration with associated foot oedema, in response to the implementation of local guidelines.

Lesley Ogden and Dr Stephanie Honey describe a study which aimed to elicit patients' views of a new, pilot, community leg ulcer clinic.

Ellie Lindsay discusses the need for community nurses to address the research-practice gap and incorporate evidence based findings into their daily work.
Ellie Lindsay BSc (Hons), RN, DN, CPT, Dip HE is a Independent Specialist Practitioner and Associate Lecturer CRICP, Thames Valley University, London; Ellie also is a Visiting Fellow, Queensland University of Technology, Australia. Article accepted for publication: June 2005
Leg Club® the wording and logo are protected by Registered Trade Mark in the UK and Australia. If you require further information about the Lindsay Leg Club model, please visit the website at www.legclub.org or email Ellie Lindsay at ellie@legclub.org.