The Best Practice Statement "Addressing complexities in the management of venous leg ulcers" provides the most up-to-date guidance on caring for the estimated 731,000 leg ulcer patients in the UK.
Written by an expert panel to:
The Best Practice Statement highlights that compression is an integral component of VLU management. The document presents a pathway to underpin decision making which supports self-care solutions when appropriate. Our product solutions have been inserted to the pathway below to show you how you can implement the generic pathway in the document.Download the pathway
NHS reforms and the extent of the problem of venous leg ulcers, made the panel challenge the myths that underpin ritualistic practice.
Can you match the Myths with the Truths identified in the Best Practice Statement?Show myths & truths
A wound must be present on the limb for at least 6 weeks to be classed as a leg ulcer and therefore treated with compression.
The definition adopted by the BPS panel indicates that if the wound has been present for over 2 weeks, the patient should be assessed for suitability of compression. Immediate treatment of a lower limb wound with compression where appropriate, particularly if venous signs are present, will prevent ulcer development and reduce burden to the patient and to healthcare delivery.
ABPI assessment conﬁrms the presence of a VLU.
Whilst a fundamental component of assessment, ABPI assessment will not diagnosis venous disease — it will only exclude the presence of signiﬁcant arterial disease — and is only a component of a full holistic assessment.
If a wound is healing, the surrounding skin does not require management.
Outcomes associated with compression will be improved if surrounding skin is managed effectively (including safe removal of hyperkeratosis).
Superabsorbent dressings cannot be used under compression and should be used over compression if required.
Superabsorbent dressings can be used under compression if the product effectively contains exudate to prevent maceration. They should not be used over compression, as sub—bandage materials and bandages soaked in exudate could result in further damage of surrounding tissues.
Compression should be stopped if the patient has cellulitis.
Compression treatment should be continued as long as the patient’s pain levels allow this. In the case of cellulitis, compression can help to prevent further lymphatic damage.
If a wound is small, then it will not benefit from compression during the healing process.
The decision to use compression is based upon clinical suitability for compression rather than the size of the wound. Regardless of size, venous leg ulcers require compression.
Reduced compression is therapeutic for VLUs.
While some compression is better than none, clinicians should always aim to use full compression systems when the vascular assessment deems it appropriate to do so, in order to prevent delays in healing through use of sub—therapeutic compression.
Inelastic bandages are not suitable for immobile patients.
Inelastic bandages can be used on both mobile and immobile patients, as fluctuations in pressure can be achieved even with small or passive movements to facilitate venous return.
Hosiery kits are only for self—caring patients.
Hosiery kits can be applied by the patient, carer or healthcare professional. In each of these scenarios use of a hosiery kit facilitates time efficient care delivery as well as potential quality of life improvements.
The compression system used determines the frequency of reapplication required.
The decision as to how frequently the limb needs to be reviewed should not depend on the compression system, rather the patient and the presentation. TMES principles should be considered in decision making, as factors such as tissue condition, presence of biofilm, potential for oedema reduction and surrounding skin condition should all be taken into account. Lifestyle factors should also be considered where possible, utilising selfcare solutions to enable frequency of change and improve quality of life.
Compression should not be applied to the foot.
Moderate to high compression must be applied to the foot to prevent foot oedema where there is little compression to the foot, the high compression to the gaiter region can create an oedematous foot and toes, thereby causing additional issues. The use of toe garments is recommended to aid oedema reduction.
Venous leg ulcers are not painful.
In a study examining pain in venous leg ulcers, a high proportion (64%) patients with ulcers of purely venous aetiology reported severe pain (Hofman et a1, 1997). The presence of severe pain does not necessarily indicate arterial disease or infection.
The TIME* acronym was developed as a quick and effective way to assess wounds and to promote the principles of wound bed preparation to stimulate wound healing.
The expert panel have added an ‘S’ to recognise the importance of the surrounding skin.
Debrisoft supports positive outcomes in each aspect of wound bed preparation, which is an integral part of every dressing change.
*EWMA 2004; Stephen Haynes 2007
The following table will help you apply the TIMES framework using our product solutions
The overall appearance of the wound bed indicates the ‘health’ of the tissue within the wound bed.
Devitalised tissue provides an ideal environment for microbial growth and, in most cases, should be removed to expedite healing.
Wounds contain bacteria, which may proliferate and cause infection — delaying healing, and increasing pain, exudate and malodour.
Even where infection is not apparent, healing may also be impeded by the presence of biofilm.
Exudate is a normal part of wound healing, and drying out can impede the healing process.
High levels of moisture (often containing harmful proteases) can break down new wound tissue and macerate periwound skin.
Lack of new, healthy tissue at the wound edges, or the presence of rolled edges, indicate wound healing is not progressing normally.
The wound management strategy may effect the surrounding skin — the condition of which can, in turn, affect the wound healing process.
In line with recommendations in the leg ulcer pathway, the Exudate Solution focuses on actions to take when exudate is not controlled within the dressing. It aims to greatly reduce exudate volume and progress wounds, before stepping down to a self-care solution. Where Trusts have adopted this solution in their own pathways, they have seen improved outcomes and significant savings in nursing time.
The following downloads provide further guidance on the exudate solution.