Assessment Of Leg Ulcers Research Articles

The evolution of leg ulcer guidelines and recommendations.

Clinical guidelines aim to consolidate and incorporate the latest evidence and opinion to improve patient outcomes and reduce variations in practice. This article will examine the evolution of clinical guidelines and recommendations in leg ulcer assessment and management, from the seminal Royal College of Nursing clinical guideline (1998) to the current Leg Ulcer Recommendations from the National Wound Care Strategy Program (2023). The evolving definitions of leg ulcers will be discussed, as well as the multidisciplinary approach needed to manage the underlying aetiology of this condition. A national appetite for improving leg ulcer assessment and treatment, is being informed by clinical guidelines and recommendations. The cornerstones of assessment and management remain constant, although some fundamental elements around ankle brachial pressure index ranges, historically used to aid diagnosis of leg ulcer aetiology, have been omitted in the recent recommendations.

2019 Guideline for Management of Wounds in Patients With Lower-Extremity Venous Disease (LEVD): An Executive Summary.

This article provides an executive summary of the 2019 Guideline for Management of Wounds in Patients with Lower-Extremity Venous Disease (LEVD) published by the Wound, Ostomy and Continence Nurses Society (WOCN). The executive summary presents an overview of the systematic process used to update and develop the guideline. It also lists the specific recommendations from the guideline for assessment, prevention, and management of LEVD and venous leg ulcers (VLUs). In addition, the guideline includes a new section regarding implementation of clinical practice guidelines. The LEVD guideline is a resource for WOC nurse specialists and other nurses, physicians, therapists, and health care professionals who work with adults who have or who are at risk for VLU.

Series 5, Chronic Wounds, Part 3d. Best practice statement, Holistic assessment of venous leg ulceration. Section 4: compression

British Journal of Healthcare AssistantsVol. 13, No. 6 ClinicalSeries 5, Chronic Wounds, Part 3d. Best practice statement, Holistic assessment of venous leg ulceration. Section 4: compressionMenna Lloyd JonesMenna Lloyd JonesConsultant Editor, BJHCASearch for more papers by this authorMenna Lloyd JonesPublished Online:12 Jun 2019https://doi.org/10.12968/bjha.2019.13.6.278AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Andriessen A, Apelqvist J, Mosti G, Partsch H, Gonska C, Abel M. Compression therapy for venous leg ulcers: risk factors for adverse events and complications, contraindications—a review of present guidelines. J Eur Acad Dermatol Venereol. 2017 Sep; 31(9):1562–1568. doi: https://doi.org/10.1111/jdv.14390. Epub 2017 Jul 3 Crossref, Google ScholarHarding K. Simplifying venous leg ulcer management. Consensus recommendations. Wounds International. 2015. https://www.woundsinternational.com/resources/details/simplifying-venous-leg-ulcer-management-consensus-recommendations (accessed 3 May 2019) Google ScholarNational Institute for Health and Care Excellence (NICE),(2017). Clinical knowledge summaries: Leg Ulcer—venous. https://cks.nice.org.uk/leg-ulcer-venous#!scenario (accessed 3 May 2019) Google ScholarWounds UK. Best Practice Statement, Holistic management of venous leg ulceration. 2016. https://lohmann-rauscher.co.uk/downloads/VLU_BPS_Web.pdf. (accessed 3 May 2019) Google Scholar FiguresReferencesRelatedDetailsCited byWound Care. What is new in best practice: addressing the complexities in the management of venous leg ulcers. Part 1Menna Lloyd Jones10 October 2019 | British Journal of Healthcare Assistants, Vol. 13, No. 10 2 June 2019Volume 13Issue 6ISSN (print): 1753-1586ISSN (online): 2052-4420 Metrics History Published online 12 June 2019 Published in print 2 June 2019 Information© MA Healthcare LimitedPDF download

Series 5, Chronic Wounds, Part 3c. Best practice statement: holistic assessment of venous leg ulceration. Section 2, classification; and Section 3, wound and skin management

British Journal of Healthcare AssistantsVol. 13, No. 5 ClinicalSeries 5, Chronic Wounds, Part 3c. Best practice statement: holistic assessment of venous leg ulceration. Section 2, classification; and Section 3, wound and skin managementMenna Lloyd JonesMenna Lloyd JonesConsultant Editor, BJHCASearch for more papers by this authorMenna Lloyd JonesPublished Online:7 May 2019https://doi.org/10.12968/bjha.2019.13.5.226AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Harding K. Simplifying venous leg ulcer management: consensus recommendations. Wounds International. 2015. https://www.woundsinternational.com/resources/details/simplifying-venous-leg-ulcer-management-consensus-recommendations (accessed 17 April 2019) Google ScholarJones ML. Series 5, Chronic Wounds, Part 3b. Best practice statement, Holistic assessment of venous leg ulceration. Section 1: assessment. British Journal of Healthcare Assistants. 2019; 13(4):168–170 Link, Google ScholarNational Institute for Health and Care Excellence. Clinical knowledge summaries: leg Ulcer—venous. Scenario: venous leg ulcer. 2017. https://cks.nice.org.uk/leg-ulcer-venous#!scenario (accessed 17 April 2019) Google ScholarSutherland M, Parent A. Diagnosis and management of cellulitis: dermatology perspective. British Journal of Community Nursing. 2017; 22(6):272–275 Link, Google ScholarWounds UK. Best practice statement. Holistic management of venous leg ulceration. 2016. www.wounds-uk.com (accessed 17 April 2019) Google ScholarWounds UK. Best practice statement. Improving holistic assessment of chronic wounds. 2018. www.wounds-uk.com (accessed 17 April 2019) Google Scholar FiguresReferencesRelatedDetails 2 May 2019Volume 13Issue 5ISSN (print): 1753-1586ISSN (online): 2052-4420 Metrics History Published online 7 May 2019 Published in print 2 May 2019 Information© MA Healthcare LimitedPDF download

Series 5, Chronic Wounds, Part 3b. Best practice statement, Holistic assessment of Venous Leg Ulceration. Section 1: assessment

Series 5, Chronic Wounds, Part 3b. Best practice statement, <i>Holistic assessment of Venous Leg Ulceration</i>. Section 1: assessment

Implementation of the Champions for Skin Integrity model to improve leg and foot ulcer care in the primary healthcare setting.

To facilitate evidence-based leg and foot ulcer management through implementation of the Champions for Skin Integrity model to education in primary health care in Australia. Leg and foot ulcers are frequently seen wounds in general practice and wound care the most frequently performed activity by practice nurses. The literature reports the lack of evidence-based leg and foot ulcer assessment, management and prevention strategies in this setting, and previous research in regard to confidence and knowledge has indicated that general practice health professionals have the greatest need for education in wound care. Pre-post, nonequivalent group research design. The Champions for Skin Integrity model of evidence-based wound management utilised strategies including workshops, development of Champions and use of resources. Pre- and post-implementation health professional surveys and patient clinical audits were completed. Descriptive statistics were calculated for all variables. Paired t tests identified statistically significant differences between the pre/post staff survey data. STROBE guidelines for reporting were followed (See Appendix S1). One hundred nine general practice healthcare professional staff attended the workshops. Significant outcomes were noted in increased levels of confidence in ability to assess, manage and prevent all types of leg and foot ulcers, as well as to apply evidence-based practice and change management following workshops. Pre- and post-skin audits also indicated an increase in evidence-based practices. Implementation of Champions for Skin Integrity strategies in this sample of primary healthcare professionals in general practice fostered a positive change in evidence-based wound management, assessment and prevention. The Champions for Skin Integrity model has supported increases in evidence-based practices in treatment and management of wounds in primary healthcare professionals, similar to the positive outcomes gained in the aged care setting. This is likely to lead to positive outcomes for those with wounds in this setting.

Series 5, Chronic Wounds, Part 3a. Best practice for the holistic management of venous leg ulceration: developing best practice and introduction

British Journal of Healthcare AssistantsVol. 13, No. 3 ClinicalSeries 5, Chronic Wounds, Part 3a. Best practice for the holistic management of venous leg ulceration: developing best practice and introductionMenna Lloyd JonesMenna Lloyd JonesConsultant Editor, BJHCASearch for more papers by this authorMenna Lloyd JonesPublished Online:10 Apr 2019https://doi.org/10.12968/bjha.2019.13.3.117AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Franks P, Barker J, Collier M et al.. Management of patients with venous leg ulcer: challenges and current best practice. J Wound Care. 2016 Jun; 25(Suppl 6):S1–S67 Link, Google ScholarGuest JF, Ayoub N, McIlwraith T et al. (2015). Health economic burden that wounds impose on the National Health Service in the UK. BMJ Open. 2015 Dec 7; 5(12):e009283. doi: https://doi.org/10.1136/bmjopen-2015-009283 Crossref, Google ScholarHarding K, Dowsett C, Flas L et al.. Simplifying venous leg ulcer management. Consensus recommendations. Wounds International. 2015. https://www.woundsinternational.com/resources/details/simplifying-venous-leg-ulcer-management-consensus-recommendations (accessed 8 February 2019) Google ScholarJones ML. Series 5; Chronic Wounds. Part 2.1. Leg ulcers: anatomy and physiology. British Journal of Healthcare Assistants. 2019; 13(1):11–13 Link, Google ScholarMilne J, Jones L. Evaluation of the sequential use of products embedded into a structured care pathway for leg ulcer management. Wounds UK. 2018; 14(5):98–104 Google ScholarNazarko L. Simplifying the management of venous leg ulcers: choosing appropriate and acceptable compression therapy. Br J Community Nurs. 2017 Jun; 2(22)(Sup6):S6–S12. doi: https://doi.org/10.12968/bjcn.2017.22.Sup6.S6 Link, Google ScholarNational Institute for Health and Care Excellence. Clinical knowledge summaries: leg ulcer—venous. 2017. https://cks.nice.org.uk/leg-ulcer-venous#!scenario (accessed 8 February 2019) Google ScholarTolmine EP, Rice AM. Best-practice statements; should we use them? Nurs Times. 2015 Oct 14–20; 111(42):12–14 Google ScholarVuolo J. Wound care, made incredibly easy. 1st UK edn. London: Lippincott Williams & Wilkins; 2009 Google ScholarWounds UK. Best Practice Statement: holistic management of venous leg ulceration. 2016. https://lohmann-rauscher.co.uk/downloads/VLU_BPS_Web.pdf (accessed 8 February 2019) Google Scholar FiguresReferencesRelatedDetailsCited bySeries 5, Chronic Wounds, Part 3b. Best practice statement, Holistic assessment of Venous Leg Ulceration. Section 1: assessmentMenna Lloyd Jones10 April 2019 | British Journal of Healthcare Assistants, Vol. 13, No. 4 2 March 2019Volume 13Issue 3ISSN (print): 1753-1586ISSN (online): 2052-4420 Metrics History Published online 10 April 2019 Published in print 2 March 2019 Information© MA Healthcare LimitedPDF download

Improving patient outcomes through the implementation of a person-centred leg ulcer pathway.

To develop a holistic pathway for leg ulcer assessment and management, implemented within a local community organisation. The primary aim for this pathway was to reduce time-to-healing. A leg ulcer pathway was designed to be used in all care settings to support continuity, and contains quality of life (QoL) assessment tools, a treatment algorithm, guidance for use, a leg ulcer assessment form, and a wound treatment chart. Data analysis, carried out 12 months after implementation, compared pre- and post-averages for ulcer time-to-healing: 123.7 days (median: 84 days), n=46 pre-implementation, versus 69.1 days (median: 46 days), n=30 post-implementation, respectively, which demonstrated a minimum 44% reduction in time. Cost saving analysis demonstrated a minimum cost reduction of 45% in nursing time. The implementation of a structured, person-centred leg ulcer pathway has provided many benefits to patients, clinicians and the hospital and community trust. Enhancing correct dressing product placement by ensuring the right dressing is used at the right time, in tandem with the correct compression regime, improved healing outcomes. The patient journey has become more streamlined providing the best chance to achieve full healing quickly.

Assessing the value of practice-based leg ulcer education to inform recommendations for change in practice.

The purpose of this paper is to assess the value of accredited leg ulcer education in influencing changes in practice. This is a before and after educational evaluation that adopted a qualitative survey approach of 12 primary care nurses attending the Nurse-Led Assessment and Management of Leg Ulcers accredited CPD module at a London university. The findings revealed that 6 out of the 8 nurses who completed the final interviews were satisfied that all learning outcomes for the module had been met. All of the nurses commented they had changed at least one aspect of practice following the module with the majority stating a number of improvements had been made relating to improved knowledge, practical skills, treatment and patient concordance. The evaluation was limited to a small cohort of primary care nurses and further longitudinal research is required to investigate the effectiveness across multiple cohorts.

Fundamentals of tissue viability, Series 2.3. Wound healing

British Journal of Healthcare AssistantsVol. 11, No. 9 ClinicalFundamentals of tissue viability, Series 2.3. Wound healingMenna Lloyd JonesMenna Lloyd JonesSearch for more papers by this authorMenna Lloyd JonesPublished Online:8 Sep 2017https://doi.org/10.12968/bjha.2017.11.9.427AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Dougherty LLister S, eds (2011) Royal Marsden Hospital Manual Of Clinical Procedures. Student edn. 8th edn. Wiley-Blackwell, Google ScholarGibson D, Cullen B, Legerstee R et al. (2009) MMPs Made Easy. Wounds International 1(1): www.woundsinternational.com/media/issues/61/files/content_21.pdf (accessed 11 August 2017) Google ScholarHess T (2011) Checklist for factors affecting wound healing. Adv Skin Wound Care 24(4): 192. doi: https://doi.org/10.1097/01.ASW.0000396300.04173.ec Crossref, Google ScholarMiller MGlover D, eds (1999) Wound Management, Theory and Practice. Nursing Times Books, Dorchester Google ScholarPatel S, Maheshwari A, Chandra A (2016) Biomarkers for wound healing and their evaluation. J Wound Care 25(1): 46–55. doi: https://doi.org/10.12968/jowc.2016.25.1.46 Link, Google ScholarTimmons J (2006) Skin function and wound healing physiology. http://tinyurl.com/lvjl4km (accessed 11 August 2017) Google ScholarVuolo J (2009) Wound Care Made Incredibly Easy. 1st UK edn. Lippincott Williams & Wilkins, London Google ScholarWinter G (1962) Formation of the scab and the rate of epithelisation of superficial wounds in the skin of the young domestic pig. 1962. Nature 193: 293–4 Crossref, Google ScholarWounds UK (2017) Best Practice Statement: Holistic Assessment of Venous Leg Ulceration. http://tinyurl.com/y7483xfq (accessed 11 August 2017) Google Scholar FiguresReferencesRelatedDetailsCited byInternational consensus document. Implementing TIMERS: the race against hard-to-heal wounds. Part 2Menna Lloyd Jones8 January 2020 | British Journal of Healthcare Assistants, Vol. 14, No. 1Series 3. Wound infection 3.2. Risk factors and effective management of wound infectionMenna Lloyd Jones14 June 2018 | British Journal of Healthcare Assistants, Vol. 12, No. 6Wound healing series 2.7. Assessing wound exudateMenna Lloyd Jones12 April 2018 | British Journal of Healthcare Assistants, Vol. 12, No. 4Wound healing Series 2.6. Wound debridement, part 2Menna Lloyd Jones7 March 2018 | British Journal of Healthcare Assistants, Vol. 12, No. 3Wound healing Series 2.5. Wound debridement, part 1Menna Lloyd Jones5 February 2018 | British Journal of Healthcare Assistants, Vol. 12, No. 2 2 September 2017Volume 11Issue 9ISSN (print): 1753-1586ISSN (online): 2052-4420 Metrics History Published online 8 September 2017 Published in print 2 September 2017 Information© MA Healthcare LimitedPDF download

Clinical Characteristics of Mixed Arteriovenous Leg Ulcers: A Descriptive Study.

The purpose of this study was to identify the clinical characteristics of mixed arteriovenous leg ulcers (MLU) that differentiated them from venous leg ulcers (VLU). Secondary analysis of data from larger electronic database. The sample comprised 1007 persons with lower extremity ulcers. Two hundred sixty three individuals with MLU were compared to 744 individuals with VLU; their ankle brachial indices were 0.51-0.90 and 0.91-.30 respectively. Subjects were drawn from community care settings from across Canada. Data concerning baseline demographic and pertinent clinical characteristics including ulcer history were collected using multiple validated instruments. The Leg Ulcer Assessment Tool was used to collect demographic and pertinent medical history, The Short Form Health Survey 12 and the Euro Wuol 5D (EQ-5D) were used to measure health related quality of life, the numeric pain scales was used to measure character and intensity of pain. Groups were compared using χ or Mann-Whitney U. Individuals with MLU were significantly older, has lower body mass index, a history of smoking, and more comorbid conditions than subjects with VLU. In many cases, clinical presentation was indicative of significant arterial insufficiency including cool extremities, shiny, cracked and inelastic skin, impaired capillary refill, and weak pedal pulses. Ulcer pain was highly prevalent, but overall pain rating was similar between groups. Mixed arteriovenous leg ulcers were associated with lower health related quality of life, greater mobility impairments, and more deficits in self-care and usual activities. Greater knowledge and understanding of the distinct characteristics of MLU is critical for appropriate screening, prevention, assessment and management of persons with this form of leg ulcer. Pain and health related quality of life factors are important considerations when evaluating and managing these patients.

Extracellular matrix assessment of infected chronic venous leg ulcers: role of metalloproteinases and inflammatory cytokines

Chronic venous ulcer (CVU) represents a dreaded complication of chronic venous disease (CVD). The onset of infection may further delay the already precarious healing process in such lesions. Some evidences have shown that matrix metalloproteinases (MMPs) are involved and play a central role in both CVUs and infectious diseases. Two groups of patients were enrolled to evaluate the expression of MMPs in infected ulcers and the levels of inflammatory cytokines as well as their prevalence. Group I comprised 63 patients (36 females and 27 males with a median age of 68·7 years) with infected CVUs, and group II (control group) comprised 66 patients (38 females and 28 males with a median age of 61·2 years) with non-infected venous ulcers. MMP evaluation and dosage of inflammatory cytokines in plasma and wound fluid was performed by means of enzyme-linked immunosorbent assay test; protein extraction and immunoblot analysis were performed on biopsied wounds. The first three most common agents involved in CVUs were Staphylococcus aureus (38·09%), Corynebacterium striatum (19·05%) and Pseudomonas aeruginosa (12·7%). In this study, we documented overall higher levels of MMP-1 and MMP-8 in patients with infected ulcers compared to those with uninfected ulcers that showed higher levels of MMP-2 and MMP-9. We also documented higher levels of interleukin (IL)-1, IL-6, IL-8, vascular endothelial growth factor and tumour necrosis factor-alpha in patients with infected ulcers with respect to those with uninfected ulcers, documenting a possible association between infection, MMP activation, cytokine secretions and symptoms. The present results could represent the basis for further studies on drug use that mimic the action of tissue inhibitors of metalloproteinases in order to make infected CVU more manageable.

Unit 3. Venous leg ulceration: effective management

Peter Vowden outlines key recommendations for effective leg ulcer assessment and management with reference to recent international consensus statements and guidelines

Wound care for injecting drug users: part 2

Part one of this article, published last week, examined the issues associated with injecting drug use and the overall management of patients presenting with injection drug-related wounds. In part two of this article, the focus is on the physical problems associated with injecting drug use, in particular the development of leg ulcers. The article provides nurses with practical guidance on assessment and management of leg ulcers, including compression therapy.

Wound care for injecting drug users: part 1

Part one of this article focuses on the types of injection-related wounds that may occur in the intravenous (IV) drug user. Strategies are identified to manage the complex needs of this patient group and practical guidance about treatment is provided to help promote good patient outcomes. The importance of nutrition in promoting wound healing is outlined. Part two next week will discuss specifically the assessment and management of leg ulcers in IV drug users.

Effective management of venous leg ulceration

Peter Vowden outlines key recommendations for effective leg ulcer assessment and management with reference to recent international consensus statements and guidelines

Topical dressings to manage pain in venous leg ulceration

The pain experienced by patients with venous leg ulceration can be severe, disabling and have an impact on their quality of life. Pain assessment should be an integral part of leg ulcer assessment, since unless pain is successfully managed, the patient may not be able to comply with compression bandaging or exercise and elevation, all of which are crucial components in the successful management of venous leg ulceration. Neuropathic pain can be difficult to identify for both patient and healthcare professional, if it is unrecognized and untreated the patient's ulceration may persist due to an inability to tolerate dressings or bandaging.

Leg ulcer management with topical medical honey

Three case studies of patients with leg ulceration are used to illustrate the effectiveness of Medihoney antibacterial wound gel (Medical honey) in wound healing via wound bed preparation. The aim was to improve the patient's quality of life, during the healing process, through provision of comfort, reduction in pain and protection from infection. Three patients with chronic leg ulceration were assessed as potentially benefiting from the action of medical honey to achieve wound healing. Patient selection was based on structured leg ulcer assessment. The aetiology of ulceration in patient 1 was mixed arterial and venous, and in patient 2 and 3, venous. All had several years' history of reoccurrence. Promotion of healing occurred in all instances with a reduction in the incidence of infection, reduction in pain and the provision of comfort. Antibacterial medical honey should therefore be considered as a dressing option when assessing and managing chronic wounds.

Changes in leg ulcer management practice following training in an Irish community setting

To identify regional changes in leg ulcer management following leg ulcer training for community-based nurses which incorporated Doppler ankle brachial pressure index (ABPI) assessment. This was a two-part study conducted in the Irish Health Service Executive, Mid-Western Area. An initial audit in 2005 gathered details on all leg ulcer patients treated in the community in one week, including patient demographics, ulcer aetiology, assessment and treatment. The first audit was carried out before the introduction of a training course for community-based nurses in leg ulcer assessment and management. The training programme was delivered in 2005 and again in 2006. In total 30 public health nurses and community registered nurses from this region completed the course. The second part of the study involved repeating the audit in 2007. By comparing the results from 2005 with 2007 we were able to identify changes in leg ulcer assessment and management. A total of 426 and 449 leg ulcers were identified, with a prevalence of 0.12% and 0.1% in 2005 and 2007 respectively. Prevalence increased to 1.2% (2005) and 1.1% (2007) in those aged over 70 years. Most ulcers were venous in origin (63.3% in 2005 versus 68.8% in 2007). From 2005 to 2007 the number of venous leg ulcers treated with high compression increased significantly, by almost 16% (p < 0.0001). Once-weekly dressing changes increased by a significant 10%, reducing the number of dressings requiring more frequent changes (p = 0.002). Significant improvements in leg-ulcer practices were noted in the 18-month study period. The results show very significant increases in number of patients treated with high compression and a significant reduction in more than once-weekly dressing changes. These positive changes may be partly attributed to the enhanced knowledge and skills nurses gained by participating in training.

Does social support impact on venous ulcer healing or recurrence?

Much of the leg ulcer literature focuses on clinical assessment and management of chronic venous leg ulceration in order to achieve healing. Chronic venous leg ulceration, however, should be classed as a chronic or long-term condition, defined as a condition,'that is currently not curable and therefore can only be managed', although it is not generally acknowledged as such. There is an extensive body of literature which focuses on the psychosocial issues that impact negatively on the quality of life of patients with long-term conditions, such as diabetes or arthritis. These include the emotional impact of pain, social support, coping mechanisms and response to stress and treatment adherence. Health care professionals are becoming increasingly aware of the impact psychosocial issues may have on wound healing in general, but particularly, in chronic venous leg ulceration and prevention of recurrence. This article reviews the current literature on the role of social support and its impact on venous ulcer healing/recurrence and concludes that health professionals caring for patients with chronic venous ulceration need to consider alternative outcome intervention measures for patients for whom healing may not be a realistic option.