Venous leg ulcers Resources

Lower limb ulceration continues to be a common cause of suffering and its management places a significant burden on the NHS, with venous leg ulcers (VLUs) being the most common hard-to-heal wound in the UK. It is estimated that over one million patients in the UK have lower limb ulceration, of which 560,000 were categorised as VLUs at a cost of over £3 billion each year. Although self and shared care in chronic disease  management is not new, historically wound care and specifically lower limb management has been undertaken solely by healthcare professionals. This article outlines the results of implementing a lower limb wound pathway (Wounds UK, 2016), and a lower limb self-care delivery model measuring clinical outcomes and the impact on workforce pressures through limiting face-to-face healthcare professional contact up to one appointment every six weeks, when capacity and capability criteria are met. A suitability assessment was conducted and, when appropriate, patients were
managed using a self-care delivery model. Patient data were collected, anonymised and independently analysed, comparing time to healing against data on file from a previous audit using the lower limb wound pathway (Wounds UK, 2016). This highlighted VLUs in 84 of the 95 patients selected for the self-care model had healed by week 24 and a
further 10 patients had healed by week 42, with only one remaining patient reaching 42 weeks without healing. These results support the hypothesis that when suitable, patients with a VLU can self-care and deliver clinical effectiveness without compromise.

The problem of delayed wound healing has been highlighted in several publications which has stimulated debate on variance and the need for updated care pathways. This paper demonstrates how adjunctive therapy can be added to the ‘standard care’ model, described in the National Wound Care Strategy Programme’s recommendations for lower limb wounds, to enhance outcomes for patients with ‘hard-to-heal’ lower limb wounds (NWCSP, 2020). A decision-making pathway based on published literature is described,  which uses wound assessment and observed response to treatment to allow the effective and targeted introduction of adjunctive therapies for ‘hard-to-heal’ wounds. This approach will allow the cost-effective introduction of new and evolving therapies, such as WoundExpress™(Huntleigh Healthcare), which addresses the underlying problems associated with resistant lower limb oedema and compromised venous function. The pathway also indicates how other adjunctive or innovative topical wound-based treatments can be integrated to optimise outcomes while providing cost-effective care.

This article explores wound assessment and management, specifically the management in a challenging group of patients who inject drugs. It describes the development of a service to meet their specific needs and how this service has flexed and adapted over time. A case study is presented to showcase the assessment and subsequent management of a chronic wound, which developed as a result of injecting drugs, with Biatain® Ag Non-Adhesive with 3DFit™ Technology.

Ulceration of the lower limbs can be a painful, debilitating condition which may have a profound effect on the patient physically, psychologically, and socially. With an ageing population, it is likely that we will see greater numbers of patients suffering with chronic wounds and associated skin conditions in the coming years. Where there are variations in care, and sub-optimal treatment regimens, delayed healing may be both common and costly to the NHS. National programmes have been put in place to address these inequities, however all clinicians are integral in the management of patients with wounds to ensure that accurate assessment takes place, both on initial contact and opportunistically throughout the care period. Following assessment, appropriate treatment plans should be implemented, preventing further skin breakdown, and improving outcomes for the patient and healthcare system.

A chronic leg ulcer is defined as a defect in the skin below the knee that has persisted for more than two weeks and shows no sign of healing after three or more months (NHS, 2019). Lower limb and leg ulcer management presents a number of global health challenges in terms of nursing resources, wound care dressings and high recurrence rates. Also, the persistence and recurrence of lower limb conditions can lead to physical and emotional distress for individuals and their families, contributing to depression, lack of esteem, self-neglect, social isolation and loss of income.

Increasing pressures experienced within community nursing are having detrimental effects on the care and treatment provided to patients. Among these is the management of venous leg ulcers, where a culture of passivity has possibly developed, resulting in significant delays in measuring patients’ ankle brachial pressure index (ABPI) and reduction in the use of full, therapeutic compression therapy. As pressures increase, so does the financial burden on the NHS and associated psychosocial impact often experienced by patients living with lower limb ulcers. Urgent reform of leg ulcer services is required to better manage these conditions and improve the quality of care received by patients. This article provides evidence from examples of successful service transformation, and puts forward recommendations for future practice.