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).
Healthy eating is a topic covered widely in the media, and is particularly relevant to healthcare, with diet and nutrition vital to the management and prevention of many conditions. Wound healing is a complex process that relies on the coordination and internal regulation of activities such as the removal of devitalised tissue and growth of fresh blood vessels. This article examines the phases of wound healing and discusses how nutrients can affect and enhance this process. Understanding the role of nutrients in wound care enables nurses to offer advice to patients whose wounds are not progressing in the expected manner. Nutrition should form part of holistic wound assessment, with any malnourished patient being referred to a dietician. It is a misconception that only underweight individuals can be malnourished and the use of a robust assessment tool will assist nurses in deciding which patients require onward referral. There appears to be a significant link between poor nutrition and delayed wound healing, with a higher risk of complications such as infection identified in malnourished patients
The third in this four-part series about understanding compression explores the use of both compression hosiery and adjustable compression wraps. The case for early intervention, as well as the need to see compression as a lifelong treatment for those diagnosed with venous disease, are also discussed. In addition, the differences and similarities, advantages and limitations of compression hosiery stockings, two-layer compression hosiery kits and adjustable wraps will be deconstructed.
The scientific and clinical focus on honey which has come about in the past 30 years has led to the classification of medical grade honey and the commercial availability of highly regulated products. Medical grade honey has proven antibacterial activity, traceability of source, and lack of contaminants. It is gamma-irradiated to kill bacterial spores that may be present in raw honey (Amaya, 2015; Cooper, 2016). It is available in a wide range of products, including sterile tubes of honey ointment, honey impregnated tulles, alginates, gels and meshes.
Lower limb ulceration is a common, debilitating and costly condition that accounts for over one third of chronic wounds in the UK. The most common underlying causes of leg and foot ulceration are venous insufficiency, arterial insufficiency, lymphoedema and diabetic neuropathy. More than half of leg ulcers do not have a recorded diagnosis and are unlikely to receive appropriate care. Poor care can cost up to ten times as much as appropriate care. The Legs Matter campaign aims to change this situation through a public health campaign supported by a website: http://legsmatter.org. The website provides clearly written, easily accessible information for patients, the public and generalist healthcare professionals along with signposts to reputable sources of information. In this way, the campaign aims to raise awareness that leg and foot conditions can be improved with the right care.
Chronic wounds such as venous leg ulcers and diabetic foot ulcers are increasing in prevalence and impose a significant burden on patients and the NHS alike, particularly if complications related to delayed healing occur, such as infection, cellulitis or amputation. LQD® wound spray is a new primary dressing that contains chitosan FH02™. A multicentre evaluation was carried out across four centres in the UK to determine the efficacy of LQD in promoting wound healing in patients with long-standing venous leg ulcers and diabetic foot ulcers (n=39). The evaluation found that LQD promoted wound healing in almost half of the wounds (n=18), and 15 wounds made significant progress towards healing as measured by reduced wound dimensions and an increase in the healthy wound tissue present. Two wounds remained unchanged. Patients and clinicians reported that the use of LQD had a positive impact on wound progress.
Compression hosiery is the mainstay of maintenance therapy to prevent recurrence of symptoms for those with venous and lymphatic disorders. Choosing the right type of hosiery is essential to ensure that the garment meets the patient’s needs and to facilitate concordance. Resources such as the CHROSS checker tool can be valuable in the selection process. Adore® (L&R) is a European Class range of compression hosiery which is suitable for those with oedema and mild–moderate symptoms of venous disease. It was evaluated in University Hospital of North Midlands NHS Trust, yielding positive outcomes for all patients. It is effective in containing chronic oedema and, due to its sheen, will potentially facilitate concordance for those wishing to wear a more attractive garment.
Necrotising fasciitis (NF) is a rare, life-threatening condition (Laube and Farrell, 2002). It is otherwise frequently known as ‘the flesh-eating disease’, hospital gangrene and necrotising erysipelas (Tsitsilonis et al, 2013). Challenging to recognise and rapidly progressing, NF is associated with high mortality and morbidity and therefore requires aggressive treatment as soon as possible. Inconsistent signs and symptoms cause NF to easily be misdiagnosed. Healthcare professionals in primary care and the community are frequently the first contact the patient has with health services in the early stages of NF. As such, a focus on raising awareness of this condition, a culture shift to accept it as the medical emergency that it is, and a high degree of suspicion are all required to improve and maintain patient safety.
