Leg Ulcers

Whilst many people have not heard of a leg ulcer, they are surprisingly common. In fact up to 1% of adults in the UK will have one at some time in their lives and district nurses can spend up to 22% of their time treating leg ulcers.

A leg ulcer is an area of damage on the skin, below the knee or on the foot which fails to heal after several weeks. What can start out as a minor knock or scratch; (often on something everyday like a supermarket trolley) can potentially turn into a leg ulcer. For a wound not to heal, other factors are involved e.g. poor venous return, infection or diabetes.

Whilst sufferers may dismiss it as "nothing" and not seek treatment for weeks, months or even years, it is vital that any wound on the leg is seen by a nurse or GP if it has not healed within 4-6 weeks.

The majority of leg ulcers are venous in origin (70%), meaning the sufferer's blood does not flow back to the heart as well as it should, which delays healing. Until this is corrected, a leg ulcer cannot heal - which is why some patients have had an ulcer for many years.

However, on a positive note, the use of compression bandages and compression hosiery means that most venous leg ulcers can be successfully healed and will not return.

20% of ulcers are arterial (poor blood flow from the heart to the leg) with the remainder resulting from diabetes, rheumatoid disease and various other conditions.

If you have just been diagnosed with a leg ulcer or think you may have one, you are not alone. Up to 1% of the adult population will suffer from a leg ulcer at some point in their lives. A leg ulcer is a wound found below the knee on the leg or foot which has not healed after 4-6 weeks. The ulcer is often the result of something very minor, such as a scratch whilst gardening.

Having a leg ulcer can make some people feel quite depressed, especially if you are not able to go out or wear normal shoes. They can also be very painful, but this varies from person to person. Sometimes germs in the wound can make it smell and this can make you feel embarrassed or make people not wish to visit anymore. A smelly wound is not a sign that you are not clean, but it does need a doctor or nurse to sort it out. Some leg ulcers produce a lot of fluid, so you may not feel like leaving the house.

If you have a sore or wound on your leg that does not seem to be getting better (after 4-6 weeks) it is important that you go and see your doctor, or ask a doctor to see you if you cannot leave the house. Often people with leg ulcers (sores) think they will get better by themselves and do not want to bother their doctor.

Seeing the Doctor

The doctor will never dismiss your concerns and would rather see an ulcer earlier rather than later. If the sore smells or produces lots of fluids then the doctor may give you antibiotics. Normally, once a leg ulcer has been diagnosed, a nurse who specialises in leg ulcers will be in charge of looking after you.

Treatment

The type of treatment you receive depends on the type of ulcer you have. If it is a venous ulcer you will have a wound covering (dressing) put on the sore to help it heal or to get rid of any fluid or germs in the wound. Firm compression bandages will then be put on top of the wound covering.

Compression bandages give the greatest firmness at your ankle and their job is to push the blood up the veins in your leg and back to your heart. The compression bandages are very important in helping your leg ulcer to heal as they keep your blood flowing and good blood flow lets the wound heal.

The bandages and the wound covering will probably be applied by a nurse. If the wound is making lots of fluid then the nurse will change the bandages and wound covering every few days, after that you may see the nurse just once a week.

The good news is that most venous leg ulcers will get better quite quickly once treatment starts. The wound may take a few months to fully heal and after it is better, you will probably need to wear compression hosiery to help prevent it coming back.

Compression Hosiery

Once your leg ulcer is better, it is important to wear hosiery to prevent it coming back. The majority of leg ulcers do come back unless you wear compression socks or stockings. Therefore, if your nurse prescribes hosiery for you, it is important that you wear it.

Modern hosiery is light, attractive and virtually indistinguishable from normal hosiery. Activa compression hosiery is the UK’s no.1 brand and comes in a range of styles and colours, including unisex ribbed or patterned socks. These can be obtained on prescription.

The first step in managing venous ulceration is to perform a holistic assessment of the patient, and any systemic or local factors which could affect wound healing should be addressed.

A visual examination will identify signs of chronic venous insufficiency and a full vascular assessment, using Doppler ultrasound and/or pulse oximetry, will eliminate the presence of significant arterial disease.

Actico - Cohesive Short Stretch Bandage

Actico is a cohesive inelastic bandaging system indicated for the treatment of venous leg ulcers. Many healthcare professionals favour inelastic bandages for their ease of application and are reassured by the fact that too much compression cannot be accidentally applied to the limb. The low resting and high working pressures are suitable for both mobile and immobile patients with healing rates that match the traditional 4 layer methods. Click here for more information on how a short stretch bandage works.

Actico Key Points Summary

• Easy application
• Applied at 100% stretch
• Non-slip
• Normal footwear can usually be worn
• Stays in place for up to 7 days
• Less bulky
• Good patient concordance
• Cost effective

ABPI (Doppler) Measurement >0.8 - < 1.2 Actico can be applied <0.8 & > 1.2 Actico should only be applied only after specialist referral and under strict supervision. Click here for further information on Actico

Patient Preference

Actico has been successfully used on patients who have not complied with 4 layer bandaging. Some patients find 4LB painful at night and Actico's low resting pressures have enabled patients to sleep pain free, and Actico's healing rates are comparable to 4LB. Click here for randomised control study. Patients like being able to wear their usual footwear which helps them continue normal activities, which can aid healing. Layers of bulky bandages often means the patient ends up wearing over-sized slippers. The ensuing shuffling makes the foot and calf pumps work less efficiently, and can make the patient feel housebound.

Pip Codes

Click here for pip codes

Applying Actico

Click here for step by step guide to applying Actico

40mmHg Leg Ulcer Hosiery Kit

Activa produces a compression hosiery kit to treat leg ulcers. Instead of bandages, a 10mmHg silky stocking is worn under a Class 3 (25-35mmHg) stocking, providing the compression required for leg ulcer healing.

Comfortable and discreet, with normal footwear generally able to be worn, the kit is ideal for self-caring patients, those with regular shaped limbs and a lowly exuding ulcer.

Post Healing: Compression Hosiery and Leg Ulcers

Compression hosiery has been clinically proven to reduce leg ulcer recurrence and is now routinely used when an ulcer has healed.

Compliance can be an issue with compression hosiery, having in the past been hard to apply and deemed unattractive by patients. Activa has challenged this perception by using new yarns and manufacturing techniques which make the hosiery attractive, soft and comfortable. In a study Activa hosiery has been shown to aid compliance. "This study showed high adherence to treatment with compression hosiery. This could be attributed to the use of Activa stockings which, in the clinic nurses' experience, patients find easier to apply and find higher rates of comfort and aesthetic acceptance. (Jenny Bentley, BJCN 2001, Vol. 6. No 3).

How to assist patient compliance

• From the onset of wearing bandages let the patients know they will then be going into compression hosiery once the ulcer has healed - and this is probably for the rest of their lives.
• Your attitude counts! If you stress how comfortable modern compression hosiery is – it is virtually indistinguishable from high street hosiery - they too will be positive.
• Ensure the patient knows how important it is they wear their hosiery to prevent their leg ulcer coming back. Compliance tends to be higher if patients understand their treatment. If they find the hosiery difficult to put on, aids are available e.g. ActiGlide.
• Let the patient be involved in choosing the colour of their hosiery, e.g. unisex socks are available in black and brown.
• Have a selection of samples to show and discuss with the patient. Activa can supply health professionals with a sample pack on request.

Hosiery Treatment Kit

Activia produces a compression hosiery kit to treat leg ulcers, ideal for patients who will not comply in bandages, or younger patients who do not wish to highlight their leg problem. Click here for more information.

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