Chronic oedema is a common condition which is increasing in prevalence, yet is still often under-recognised and mismanaged in community settings. Any oedema is a sign that the venous and lymphatic systems are not working properly. Without early identification and intervention, the condition can worsen, resulting in the need for complex care. Using a case history, this article highlights the inappropriate and ineffective use of medicinal management of a patient with lymphorrhoea (i.e. wet, ‘leaky’ legs). As a result of health assessment and a review of management and medication, deprescribing was effectively implemented in this case. The patient was provided with compression hosiery and education, and supported by a Healthy Legs clinic in the South Eastern Health and Social Care Trust, with positive outcomes for the patient, treatment room and GP. The case demonstrates how good practice uses health assessment and symptom analysis to determine diagnosis and appropriate treatment options. It also poses the question: is pharmacology always the answer?
Wound debridement and wound cleansing are considered an important part of wound management (Strohal et al, 2013). Selection of the correct cleansing or debridement method should be following comprehensive wound assessment to guide decision-making regarding appropriate cost-effective treatment. This second part in our clinical skills series discusses wound cleansing and debridement methods commonly available in primary care and their importance in wound bed preparation.
Wound healing is complex and there are many factors that can interfere with the normal healing process, which can result in an acute wound becoming a chronic, non-healing one. Cigarette smoking is frequently listed as one of the factors which can interfere with wound healing. However, it is one of the potentially modifiable lifestyle behaviours that can reduce the risk of developing a nonhealing wound (Ellis, 2018). Although the precise mechanisms as to how smoking delays healing are currently not clear (Sorensen et al, 2010a, b; Sorensen, 2012), this paper explores the literature on how smoking interferes with the wound healing process at a pathophysiological level, together with how it may be responsible for increased infection rates and delayed healing. In addition, it also discusses how smoking can contribute to infection and wound dehiscence in surgical wounds and delay healing in chronic wounds, resulting in a prolonged recovery time for the patient.
Chronic oedema is a major clinical problem worldwide (Moffatt et al, 2019a). The condition has many important secondary consequences for health, activity and participation (Moffatt et al, 2017). Its prevalence also has a significant association with the presence of a wound (Moffatt et al, 2019b). There are many challenges to managing patients in this group, which can lead to ineffective and inappropriate care and have a significant impact on patient quality of life (Green and Meskell, 2016). This article discusses some of these challenges and the impact which they may have on patients and healthcare professionals caring for them.
Surgical site infections (SSIs) are the most common type of nosocomial infection, accounting for up to 20% of all hospitalacquired infections in Europe (European Centre for Disease Prevention and Control [ECDPC], 2013). There are varying SSI rates reported across the UK. In 2016, Public Health Wales reported an overall 14-day SSI rate for women undergoing caesarean section of 4.35% — 83% of which were superficial infections and 92.5% were detected after discharge (PHW, 2016). From 2015–2016, Aneurin Bevan University Health Board (ABUHB) services experienced an increase in the SSI rate for women birthing by caesarean section from 3.07% to 5.86% respectively. Therefore, a multifaceted approach to quality improvement (ABUHB organisational method) was adopted throughout the duration of 2017, with a view to implement by 2018. The aim was to reduce SSIs for women birthing by caesarean section in ABUHB. Interventions included the use of evidence-based practice and guidelines, education and engagement among clinicians, patients and staff, and the gradual implementation of Leukomed® Sorbact® (Essity) post-operative dressings.
