Assessing and managing patients with leg ulceration and oedema
Leg ulcers are some of the most common wounds treated by the NHS. Ulceration is usually classified as being of venous or arterial origin. Arterial ulcers develop because of reduced arterial flow to the leg caused by peripheral arterial disease. Venous leg ulcers, the most common form, develop because of vein incompetence, with valve failure leading to pressure in the veins. Nurses working with patients with oedema find that chronic oedema can cause the limb affected to swell, causing skin to stretch and break and lead to ulceration. This is known as superficial ulceration. This article discusses the causes, assessment and management of these different types of leg ulcer.
A retrospective cohort analysis of patients' records estimated there were 2.2 million wounds in 2012/2013 in the UK, costing the NHS between £4.5 and £5.1 billion (Guest et al, 2015). Extrapolation of the data showed that almost 34% of these wounds were recorded as leg ulcers; a further 12% were unspecified wounds, which may or may not have been on the lower legs. However, population growth and healthcare costs since these data were collected means the initial estimated numbers and subsequent costs of managing wounds may be greater. Guest et al predicted that the prevalence of chronic wounds will increase by 12% per year due to delayed healing (Guest et al, 2017).
Research has shown significant inconsistencies in wound care practice including approximately 30% of wounds having no recorded differential diagnosis, and only 16% of wounds on the lower legs had a documented ankle-brachial pressure index (ABPI) (Guest et al, 2015; 2017). This suboptimal care may be contributing to delayed healing, increased risk of adverse events, and wastage of valuable resources (Andriessen et al, 2017).
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