Venous leg ulcer Resources

There is an abundance of literature on the management of venous ulceration, however, increasing numbers of patients are presenting with ulcers of mixed aetiology — arterial and venous. Compression therapy is the gold standard treatment for venous ulcers, however, high levels of compression are contraindicated in the presence of severe arterial disease. Nevertheless, the venous element of a mixed aetiology ulcer needs to be addressed, which
can pose a dilemma for healthcare professionals caring for these patients. This article discusses the different aetiologies and current literature on how these ulcers can be managed effectively to achieve healing.

Venous leg ulcers (VLUs) are known to place a significant burden on healthcare services, with unhealed ulcers costing 135% more than their healed counterparts over the course of a year (Guest et al, 2016). This is a consequence of unwarranted variation in care attributed to difficulties experienced by non-specialist clinicians caring for VLU in the community. VLU healing rates are relatively unknown, and national targets for healing do not yet exist, but there is evidence in the literature that specialist VLU services improve healing rates (Moffatt et al, 1992). Healogics is a specialist third party provider of VLU and lymphoedema services to the NHS, that takes a systematic approach to the assessment and management of these co-existing conditions. This paper presents the healing rates of 1015 people with VLU treated by Healogics for the full 65-month duration of an any qualified provider (AQP) contract. Healing rates of 86.14% were obtained in an average of 117 days in line with the published healing rates from other specialist leg ulcer services (Moffatt et al, 1992; Edwards et al, 2005). The healing rates reported in this paper demonstrate that a consistent, specialist approach to VLU management that is underpinned by best practice and national guidelines can help to achieve timely healing in the majority of patients, and can identify more complex patients for whom healing is not possible, enabling them to be placed on a maintenance pathway. The authors suggest that grading of VLUs according to complexity and data collection and analysis of healing rates could help to improve healing outcomes on a national level.

Compression therapy is a key component of venous leg ulcer management. Best practice guidelines recommend that an ankle brachial pressure index (ABPI) is determined before applying full compression to establish if peripheral arterial disease (PAD) is present. However, a recent study by Guest et al (2015) highlighted that 84% of patients with a wound to the foot or leg have no recorded ABPI. The reasons for this are thought to be insufficent time to carry out the assessment (Chamanga et al, 2014), and lack of competency (Worboys, 2006).