Chronic leg ulceration is an increasing burden in the UK, both financially to the health service and on a human level. This first article in a four-part series, which looks at leg ulcer management and understanding compression therapy, explores the cardiovascular system, the underlying causes of lower limb problems, and the risk factors for leg ulceration. An overview of how compression therapy works and an introduction to the options available for patients and clinicians in this field of practice is also given. Subsequent articles in the series will look at holistic assessment and clinical decision-making in leg ulcer management, understanding compression hosiery and adjustable wraps, as well as compression bandaging and skin care
This article is the second in a two-part series on managing common lower limb problems encountered in primary care. The first article in the series (Brown, 2017) discussed the causes of oedema and its relation to underlying conditions, such as venous disease, lymphoedema and lipoedema. This article investigates skin care, the management of ‘wet legs’ and the different types of compression therapy available to non-specialist community nurses.
This two-part series will discuss common lower limb problems, including venous leg ulceration, oedema (including oedema associated with lymphovenous disease), lymphoedema and lipoedema. This article will focus on the causes of these conditions and discusses the signs and symptoms to enable community nurses to diagnose and differentiate between the types of lower limb problems. Part two of the series will focus on management strategies for simple, uncomplicated venous leg ulceration and oedema, which can be successfully managed with skin care and compression therapy, without specialist skills. It will also briefly outline the management of lymphorrhoea or ‘leaking legs’, which can be challenging for nurses. The aim of this series is to enable community nurses to choose the most effective treatment in terms of efficacy and patient acceptability.
District nursing teams are under increasing pressure to cope with demands on their time and the skills to meet the needs of their local community. The author’s local nursing team has been struggling to manage the clinical skill mix required to meet the complex needs of their patients with lower leg wounds who should be treated with compression therapy. The task of managing compression therapy was mainly undertaken by nurses, but it was proving extremely time-consuming — especially when patients needed leg washing and compression treatment for bilateral leg wounds. After successfully using a Velcro™ compression system, a six-month evaluation of juxta products for the leg ulcer pathway was proposed for one community nursing team. This project was undertaken with an initial cohort of 17 patients to evaluate if switching to this product could help to improve the use of the team’s skill mix and reduce costs on wound products from the formulary by improving wound healing rates.
