any break in the skin of the lower leg above the
ankle
"othian and #orth $alley study%
&6 venous disease
. prevalen!e 0/, 0/1 26'-,86300044
5ppro+ , of population will have a leg ul!er at some point in their
lives 26'03000 .4
revalen!e in!reases with age
7ayside 1('3000
:North-;ast #ife
,3,&6
WHO "REA"S?
?80 of !hroni! venous leg ul!ers !ared for in the !ommunity
,' @oint eAort !ommunity and se!ondary !are 2se!ondary !are
spe!ialists !an be Dermatologists3 $as!ular <urgeons3 lasti!
surgeons3 7issue viability teams et!/4
) in patient treatment 2'00' >gures4
*orbidity pain3 sepsis3 e+udate3 odour et!
mpaired =uality of life
#inan!ial !ost 2.4
2'00, pri!es4
• Diabeti!
• $as!uliti!
• *alignant
History duration of present ul!er/ s this their >rst
ul!er:
ainF disturbing sleepF aAe!ting mobility
0/1/3 #orma
Iound swab - JN"K f ul!er in!reasingly
painfulGe+udativeGsmellyG
enlarging
at!h testing - 7o previous ul!er treatments eg/ Bandages3
dressings3 !reams
Duple+ s!an if indi!ated
No#ad,ere#t dressi#"
Deso%",i#" a"e#t i6 #ecessar! e" ,!dro"e* ,o#e!
7 a!er compressio# +a#da"i#" 8 ma! #eed to i#crease compressio#
"rad%a! i6 pai# a pro+em
Le" eeatio#
5pplied by a trained nurse
Non-adherent dressing
Class ,2weak4 to !lass 1 2strong4/
*ost patients manage !lass ' sto!kings
S$GN %&'
,45ll patients with !hroni! venous leg ul!er should have an 5B
performed prior to treatmentE
'4*easurement of 5B should be performed by appropriately trained
pra!titioners who should endeavour to maintain their skillsE
14Compression should only be applied by staA
with appropriate trainingE
Luidelines not being followed
atients suAering an unpleasant3 painful and life-altering !ondition
for far longer than they need to
Trai#ed sta66 to app! compressio#
Reassess i6 #ot improi#"
>or di66ic%t 9o%#ds co#sider ot,er treatme#ts* re6erra to
seco#dar! care
a. 0/=
,//ectin t+e loer le is2
a. ?aricosit!
#+ic+ o/ t+e /olloin dressins +e,l ulcers4
a.A;%ace AG
c.&ot, o6 t,e a+oe
d.No#e o6 t,e a+oe
W(at i! !lou(?
W(ic( ulcer! !(ould 5e !4a55ed?
a4 Iarm tap water and soap substitute
b4 <terile saline solution
,UES"$ON %%
M W(ic( o) t(e )ollo4in could 5e t(e cau!e o) a non:(ealin le
ulcer?
a4 <kin !an!er
,UES"$ON %&
M W(ic( o) t(e!e condition! are i6portant in t(e 6anae6ent o) le
ulcer!?
a4 Cardiovas!ular disease
,UES"$ON %.
M W(ic( o) t(e!e i! a co66on !ite )or 7enou! ulcer!
a4 Heel
!4 <hin
d4 !alf
b4 7o e+amine the vari!ose veins prior to surgery
!4 7o assess the arterial system
d4 7o measure o+ygen levels in the feet
,UES"$ON %0
M W(at !(ape are ;ou ai6in )or 4(en paddin and !(apin a le prior to
5andain?
a4 Jval
b4 e!tangle
!4 Cone
d4 7riangle
,UES"$ON %2
M W(at i! t(e 6o!t i6portant t(erap; in (ealin le ulcer!?
a4 Dressings
b4 5ntibioti!s
,UES"$ON %3
M Once a 7enou! ulcer i! (ealed< 4(at !(ould t(e patient 5e
ad7i!ed to do?
a4 Nothing
d4 b and !
a4 9-6 months
b4 <tandards of investigation network
!4 <!ottish inter-!ollegiate guidelines network
d4 <omebody issues guidelines network
