Leg Ulcers Flashcards
What is the definition of a chronic leg ulcer?
Open lesion between the knee and ankle joint that remains unhealed for at least 4 weeks
What are type of ulcer are most leg ulcers?
Venous leg ulcers (60-80%)
How common are other types of leg ulcers, besides venous ulcers?
22% arterial disease
9% rheumatoid arthritis
5% diabetic
10-20% mixed arterio-venous
What is the UK prevalence of leg ulcers?
0.1-0.3% (increases with age), about 1% of population will have leg ulcer at some point
Where are most chronic venous leg ulcers treated?
In the community (>80%), 12% treated as joint effort between community and secondary care, 5% treated as in-patient
How can leg ulcers impact on patients?
Reduce quality of life, distressing symptoms (pain, leakage, smell, infection, social isolation)
How much does it cost to treat one leg ulcer?
£1500 per annum
Why do leg ulcers cost so much?
Delay in full assessment and diagnosis
Delay in ABPI’s or none at all
Delay in commencing treatment
Lack of confidence in compression application
Expensive dressings and inappropriate use
What are the types of leg ulcer?
Venous, arterial (or mixed arterio-venous), vasculitic, malignant, inflammatory, hydrostatic (dependant limb)
Why are holistic assessments of leg ulcers important?
They help determine the cause of the ulcer
What are the main aims of assessment?
To identify clues to the underlying aetiology and factors contributing to delayed healing (SIGN 2010 suggest the use of an assessment tool)
What order should the assessment follow?
Assessment of patient, then leg, then the ulcer itself
What should be included in the assessment of the patient?
Past medical history, current medication, social circumstances, smoker (past or present), mobility, pain, sleep disturbance
What should be recorded in the assessment of the ulcer?
Its position, measure surface area
What are some features of vasculitis?
Painful, sudden onset, purpuric rash/pustules, necrotic
What are some investigations that can be done for a leg ulcer?
ABPI Wound swab Bloods (FBC,LFTs, U+Es, CRP) Patch testing (to previous ulcer treatment e.g bandages, cream) Duplex scan (if indicated)
Why should ABPI be done?
To establish if there is arterial disease
When should a wound swab be taken?
Only if ulcer is increasingly painful/exudate/malodour/enlarging
What does ABPI stand for, and what are the diagnostic ranges?
Ankle/Brachial pressure index: 1.0 = normal 0.8-1.3 = compress <0.8 = vascular disease >1.5 = calcification (according to SIGN 2010)
How should venous leg ulcers be treated?
Control pain and use ABPI
Non-adherent dressing (seldom heal wounds on their own)
De-sloughing agent if necessary (e.g hydrogel, honey)
4 layer compression bandaging (may need to increase compression)
Leg elevation
What are some features of compression stockings?
Class 1 (weak) to class 3 (strong), most patients tolerate class 2 stockings, latex/rubber free if possible, non-adherent dressing
How does the 4 layer bandaging system work?
By using graduated compression, leg padded to cone shape and changed weekly (or as required)
What should the pressure be at the ankle and below the knee when using the 4 layer bandage system?
40mmHg at ankle, 25mmHg below knee
Who should apply compression stockings?
A trained nurse
What are the different types of debridement?
Autolytic
Sharp debridement (with scalpel, scissors)
Biological (larvae therapy)
Surgical (under general anaesthetic)
How can wound beds be prepared?
By removing devitalised tissue by debridement
How does autolytic debridement work?
Use of dressings to create moist wound environment and hydrate necrotic tissue/eschar
How could huge cost savings be made?
If duration of ulcer reduced and prevention of recurrence addressed
When is the aim for simple venous ulcers to healed by?
12 weeks
