Patient experiences of people with leg ulcers during the COVID-19 pandemic

Chronic wounds (also referred to as hard-to-heal wounds) usually describes those that do not heal within 8 weeks. However, there are certain types of ulcers that are considered ‘chronic’ from their very beginning, such as venous and arterial leg ulcers or diabetic foot and pressure ulcers (Dissemond et al, 2017). Chronic leg ulcers (CLUs) have an estimated prevalence of 1.51 per 1000 people (Martinengo et al, 2019) and the most common types of leg ulcers are venous (80%) and arterial (15%); atypical ulcers related to other causes are rarer (5%) (Todhunter, 2019). CLUs are difficult to heal and tend to be recurrent, especially those of venous aetiology (Finlayson et al, 2018).

CLUs can have a moderate (Cunha et al, 2017) to high (Kouris et al, 2016) impact on people's quality of life due to both pain (Probst et al, 2021) and significant restrictions to daily activities (Ruseckaite et al, 2020). Pain tends to be exacerbated during the night, leading to considerable difficulty in sleeping for patients, increasing the debilitation caused by the illness (Green et al, 2018; Phillips et al, 2018; Ruseckaite et al, 2020). Pain varies in type, intensity and duration: for some patients it is more or less constant, while others have described alternating periods without pain and moments of sudden onset without apparent precipitating factors (Phillips et al, 2018). Furthermore, restrictions to daily living are mainly caused by pain and walking difficulties, but also by the use of compression bandaging that restricts movement (Green et al, 2018; Phillips et al, 2018) and by frequent appointments at the wound clinic to receive routine care (Weller et al, 2021). Restrictions to daily activities can also impact on the ability to perform and to maintain personal hygiene, and can limit the choice of clothing and footwear (Phillips et al, 2018). In addition, CLUs may produce malodorous exudate that can cause embarrassment and shame, leading people to avoid interactions with others, resulting in social isolation (Ruseckaite et al, 2020). Depressive aspects (Green et al, 2018) related to prolonged healing time and the idea of the impossibility of complete recovery (Ruseckaite et al, 2020) may be present in patients with leg ulcers, with some expressing anxiety related to fear of falling or injury, which may increase the risk of ulcer recurrence (Green et al, 2018; Phillips et al, 2018; Ruseckaite et al, 2020).