Treatment for lower leg wounds and leg ulcers
It is important that patients receive timely and effective care of lower leg wounds. This information is designed to help safely optimise the treatment of leg ulcers and lower limb conditions.
Lower leg wound or leg ulcer?
A lower leg wound can be a skin tear, laceration, surgical wound, knock to the limb or burn. These wounds should show signs of healing within 2 weeks of injury.
The problem is that any wound on a leg takes longer to heal than a wound on the arm, for example. A laceration on the shin will immediately need more supportive treatment than just a dressing or it may start showing signs of becoming a non-healing wound. These include:
- High levels of exudate / weeping
- Increase in size
- Slough
- Requirement for repeated antibiotics because of the exudate or unmanaged oedema.
Many nursing and medical professionals do not think of these simple wounds as leg ulcers. It is important that we do think like this as identifying the cause of the non-healing – such as venous disease or simple dependent oedema – can drive a more effective treatment plan.
The original incident may have been a laceration, but the driver for non-healing may be overt venous disease or mild oedema. Getting this right will mean a swift reduction in appointments – it is a real ‘invest to save’ scheme
The National Wound Care Strategy (NWCS) has been bold enough to identify that ALL lower limb wounds, regardless of the possible cause, should have access to light compression as part of an immediate treatment plan.
To stop any delay in this critical intervention, the advice is that an ABPI does not have to be performed prior to the use of light compression, unless there is evidence of peripheral arterial disease. To optimise your intervention and to reduce your future activity associated with slow healing wounds, ensure light compression is applied immediately in the form of a Class 1 sock or Type 3a compression bandage.
What a leg ulcer looks like (Picture ©Mid Yorks NHS Teaching Trust)
Below is a picture of a simple laceration showing extent of mild oedema. This needs compression to prevent it breaking down into an open wound.
Assessment
Any wound, skin tear or knock to the lower leg should be assessed and managed promptly to ensure early intervention, and prevent further deterioration and the wound becoming a leg ulcer.
Below is some useful professional guidance on what to look out for, how to use best practice to holistically assess, and how to optimise healing by applying compression promptly and correctly.
Assessment is the first vital part of determining a correct diagnosis, before devising an individual’s treatment plan.
Having an open honest conversation with your patient and looking past a medical model can give you the full picture of the lower leg issue, and the patient’s lifestyle and living/family situation so that you can accurately diagnose and signpost accordingly.
DOWNL0AD: WOUND ASSESSMENT FRAMEWORK
Remember to involve the patient in all aspects of this assessment and conversation. This empowers them, promotes self-awareness and begins their journey of self-management, resulting in better quality individual outcomes.
The NWCS have developed a shared care diary to help you work collaboratively working with your patient. When you get your patient involved, they want to heal and understand how to stay healed.
This video explores how your patient can discuss these issues with their nurse or healthcare professional. This film will help them learn to take better control of their wound.
First line treatment for new wound, lacerations & skin tear pre Doppler
After the initial holistic assessment of your patient, there are safe, first-line treatments that can prevent further deterioration while a comprehensive shared plan of care is agreed and implemented. To help you get started on prevention, our Accelerate experts have put together some useful guides:
Remember to measure the area, assess pain levels and take a photograph
In the video below Alison Hopkins explains how using light compression for a new wound, skin tear or laceration can really help patients. This is not suitable for patients who have ischemia or neuropathic issues in the lower leg.
Always remember the importance of good skin care.
Optimising compression & knowing your products
The world of compression can be a difficult place to navigate while ensuring clinical and patient safety. There are many different compression regimes to promote healing, but where someone does not have a standard leg shape or standard wound site, these standard and effective regimes may not actually work for the patient.
Often the regime needs to be individually tailored as ‘one size may not fit all’.
READ MORE: BESPOKE COMPRESSION FOR TALLER INDIVIDUALS.
We advise really getting to know which compression bandage is most suitable and will provide optimal, comfortable support. If compression therapy is not getting results, consider:
If it is staying on but not healing the wound, why?
How can you make it effective?
What level or dose of compression does the patient need for it to be effective or optimal?
Read more: ANTI-INFLAMMATORY PROPERTIES of compression
What are the next steps?
As professionals, you must always understand the rationale for using compression and how to apply correctly.
You can do this for your patients by championing quality lower limb care and really understanding the benefits of tailored treatment and the theory of how compression works.
Our top compression bandaging tips:
- Bandage from toe to below knee, never from ankle – we have seen this
- Always encourage the patient to point their toes to their nose before bandaging
- Do not over use wadding (K soft) – ensure adequate protection to bony prominences only
- Think about footwear – can a shoe be applied? This video is a one stop shop of understanding the importance of a good fitting shoe, the benefits it can bring and where to buy appropriate footwear for all wound and lymphoedema patients.
- Practice makes perfect and a fun exercise with family, especially during lockdown!
As professionals, we can always improve our practice and embrace change as healthcare so often does. If you need further education or support why not take a look at our Education Programme delivered by experts at Accelerate.
Below are some great videos to guide you from first line treatment to safely getting the best from this critical therapy.
Optimising compression – the use of Class 1 hosiery for early intervention
A short video to explain the use of Class 1 hosiery for treatment of lower limb conditions.
Optimising compression – increasing the effectiveness
Optimising compression is at the heart of the work undertaken at Accelerate. This video guides and explains how to apply a short stretch bandage (Actico) from foot to below knee to give a really good squeeze of compression effectively and safely. Full of helpful tips and tweaks to a standard regime of application it should help you to improve and maintain the bandage.
Optimising compression – increasing the therapeutic dosage
This short video from Accelerate presents the next step in optimising the therapeutic dose of compression for lymphorrhoea and wound care after an ABPI. By gradually increasing compression, you can support a patient’s expectations and reduce pain levels. Knowing your bandages is a great start to optimising treatment.
Optimising compression – early intervention wounds lymphorrhoea
A short video on early intervention in the management of Lymphorrhoea (leaky legs) and how to optimise treatment. Produced to help you ensure wet legs, erosions and sores are dealt with promptly to reduce further risk of pain, leaking and swelling.
For further videos about correct bandage application see below links:
What to look out for
Coronavirus (COVID-19) makes it more important than ever that you and your patient know what to look out for, including any sign of infection, to reduce further risk or even hospital admission. Ensure patients know who to contact and guide them in some of the questions the nurse may ask them to establish what’s going on.
Observe for:
- Redness to skin surrounding wound
- Skin surrounding wound is warmer than normal
- Wound has become painful
- Swelling and hardening
- Increased wetness from wound
- Offensive smell
- Yellow or green pus
- If wound deteriorates / gets larger or deeper
- High temperature (fever)
- Feeling generally unwell
Always seek GP or specialist help if uncertain
Exercises for patients
Communicating the importance of exercise to patients is vital to them understanding of the benefits daily exercise on their healing. Furthermore, it can reduce swelling which will allow improved blood flow to the affected area speeding up recovery.
The overall benefits of exercise are widely known but often overlooked. Perhaps encourage patients to have exercise goals and keep a record of what they achieve with the Accelerate exercise diary.
The importance of introducing self-management to patients, they want to heal, help them make this happen.
How we can help you
At Accelerate, education matters to us – a lot. It is an important part of our work. It enables transformations in local services, healing rates and patient experience.
Referrals
We welcome online referrals from healthcare professionals from both contracted, local and non-contracted national areas. All online referrals are made using secure, safe connections and data transfer.