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Caring for patients with leg ulcers continues to be a challenge for healthcare professionals, particularly since the current healthcare climate of an ageing population, increased incidences of obesity and diabetes, as well as other comorbidities can complicate their management (Todd, 2014). It is estimated that 1% of the population suffer from leg ulcers at some point in their lives (Callam, 1992; O’Meara et al, 2009), and in those over 65 years this increases to 3–5% (Mekkes et al, 2003). Furthermore, it has also been suggested that at least 70% of all ulcers are venous in origin (Anderson, 2006), with the annual incidence of venous leg ulcers being at least 100,000 (Posnett and Franks, 2008), costing the NHS approximately £400m per year — including recurrence rates and nurses’ time. Indeed, 13% of district nurses’ workload involves management of venous leg ulcers (Simon et al, 2004).
Living with a chronic venous leg ulcer can be both socially and psychologically distressing, yet the impact is often underestimated. Healthcare Professionals often focus on ‘healing’ the ulcer, rather than the affect symptoms such as malodour can have on a person’s ‘quality of life and wellbeing’(1). The ability for the patient to smell their ulcer can influence how they undertake everyday activities and interact with others, as they often fear that other people can smell the wound. Patients may become more withdrawn and restrict social activities, additionally the fear that others can smell the wound can cause distress, embarrassment, low self-esteem, and have a negative impact on healing (1).
Caring for patients with wounds of the lower limb continues to be challenging, particularly in the current climate of budget restrictions and an ageing population. In patients over the age of 65 years incidence increases from the average 1% of the population to 3-5% (1). When choosing a compression bandage system, patient lifestyle and mobility need to be taken into consideration, as this will affect concordance with treatment (2).
One of the most common problems community nurses will come across in their day-to-day practice are leg ulcers. Of these, venous ulcers are easily the most common, outstripping arterial and diabetic foot ulcers (Scottish Intercollegiate Guidelines Network [SIGN], 2010). According to SIGN (2010) ‘venous ulcers develop as a result of venous valve incompetence and calf muscle pump insufficiency which leads to venous stasis and hypertension’.
Wound care is a specialty that has grown particularly challenging for clinicians in recent times, in part because of a massive rise in the number of treatment options available as well as advances in scientific diagnostic tools, both of which have made managing wounds a more complex business, particularly for non-specialist clinicians. However, there is one area in which best practice is fairly well established — leg ulcers.