Irene Anderson

Treating patients with venous leg ulcers in the acute setting: part 1

Leg ulcers present with a variety of aetiologies, sometimes in combination. The most common aetiology is venous, with treament involving compression, elevation and exercise; the most common treatment setting is the community. However, people with leg ulcers do sometimes require admission to hospital for conditions and situations which may, or may not, be ulcer-related. There is a lack of contemporary evidence on the experience of inpatients and insufficient analysis of the impact on healing and complications to the lower limb when patients with leg ulcers and compression therapy are admitted to hospital. Admission to hospital presents an ideal opportunity for a focus on leg care and potentially enhancing healing rates of patients. The reality for patients with venous leg ulceration being treated with compression therapy is that this does not continue if they are admitted to hospital as inpatients-having been interrupted for MRSA screening and skin assessment, often no-one is available to reinstate the therapy. This article highlights key issues in the ongoing care of these patients and offers suggestions for basic management until a more acceptable and evidence-based solution can be found. Part 2 will deal with the preparation for discharge and options for the treatment of patients who are not already in the care of community services.

Optimising concordance with compression hosiery in the community setting

Compression hosiery is used to help prevent leg ulcer recurrence by controlling venous backflow and the build-up of lower-limb oedema. The therapy is effective, but only if it is worn consistently by patients. In order to promote concordance with ongoing management, it is important that practitioners are aware of the options available in terms of design, structure, colour and size of compression. It is also vital for practitioners to consider a range of strategies to help patients apply and remove the hosiery.