Lower Limb and Leg Ulcer Assessment and Management Lower Limb and Leg Ulcer Assessment and Management is an indispensable resource for practitioners in primary and secondary care, offering a practical and accessible guide to treating and managing leg ulcers.
This comprehensive text challenges the misconception that leg ulcers are invariably ‘chronic’. In practice, proactive management will prevent the harm associated with sub-optimal management. Insights are provided into lower limb assessment, early intervention for ulcer prevention, ulcer types and their causes, along with the influence that swelling and biomechanical changes have on the lower limb. The authors draw on international best practice guidance on lymphoedema, wound pain, wound bed preparation, compression therapy, psychological impact, and evidence-based care to enhance leg ulcer management.
Each chapter aims to facilitate reader comprehension and promote productive patient discussions, empowering healthcare professionals to collaborate with patients and improve leg ulcer management rapidly and effectively.
This multi-disciplinary resource covers:
Normal venous, arterial, and lymphatic function in the lower leg Leg ulceration due to venous hypertension, peripheral arterial disease, and lymphoedema Leg ulcers of unusual aetiology, addressing autoimmune and inflammatory disorders such as pyoderma gangrenosum, rheumatoid arthritis, scleroderma, sickle cell, and more Musculoskeletal changes in the lower limb, assessment, and management to enhance mobility and calf-muscle function Clinical management, with topics like wound management, stages of wound healing, exudate management, holistic assessment including vascular assessment, compression therapy, and Laplace’s law Pain management with an emphasis on understanding the complexities and features that exacerbate or diminish the pain response The personalisation of care, understanding of social determinants of health, and the role of supportive self-management in lifelong management
For professionals seeking evidence-informed approaches to delivering exceptional care, Lower Limb and Leg Ulcer Assessment and Management is an essential companion on the journey to understanding and managing leg ulcers effectively.
List of Contributors xiii Foreword xv Preface xvii Acknowledgements xx Introduction 1 Alison Hopkins and Joseph Montgomery The Wound Care Burden 1 The Cost of Sub-Optimal Wound Care 3 Classification of Dressing Products 4 Dressing Product Analysis 6 Online Non Prescription Services 7 Conclusion 9 References 9 Chapter 1 Aetiology 11 Aby Mitchell Normal Venous Function 11 Veins in Action 16 Blood Pressure in Veins and Capillaries 17 Venous Disease 18 Pathophysiology of Chronic Venous Disease 19 Theories of Tissue Damage 21 Chronic Venous Insufficiency 23 Risk Factors for Venous Insufficiency 24 Arterial Disease 24 The Skin 33 Wound Healing 35 Phases of Wound Healing 36 Conclusion 39 References 39 Chapter 2 Lymphoedema and Chronic Swelling 43 Caitriona O’Neill and Rhodri Harris Function of the Lymphatic System 43 Prevalence and Key Facts 48 Causes of and Risk Factors 52 Assessment, Diagnosis and Staging 55 Management Challenges 66 Lymphovenous Disease 68 Treatment 74 Compression Therapy and Assessment Considerations 76 Adjunct Treatment Modalities 79 Surgery 82 Palliative Care 83 Lipoedema 87 Summary 97 References 97 Chapter 3 Atypical Causes of Leg Ulceration 106 Sarah Bradbury and Kirsten Mahoney Inflammatory/Autoimmune Disorders 107 Metabolic Disorders 134 Malignant/Neoplastic Wounds 145 Drug- Induced Leg Ulcers 155 Erosive Pustular Dermatosis 161 Infective Conditions 172 Conclusion 176 References 177 Chapter 4 Musculoskeletal Factors in Leg Ulcers: Assessment and Management 188 Rona Frances Campbell Risk Factors 190 Lower Limb Veno-Muscular Pumps 192 Ankle Joint Assessment 196 Holistic History Taking Relating to Factors that Influence Biomechanical Lower Limb Function 198 Management 205 Reducing Falls Risk 216 Allied Health Professionals as Part of the Multidisciplinary Team 218 Conclusion 218 References 219 Chapter 5 Assessment of Leg Ulceration 226 Karen Staines and Aby Mitchell Assessment 227 History Taking 227 Examination 238 Arterial Disease 248 Wound Assessment 252 Skin Assessment 263 Diagnostic Assessment 265 How to Perform a Handheld Doppler 268 Red Flags for the Urgent Treatment of Patients with Venous Leg Ulcers 276 Reassessment and Recurrence 276 Conclusion 276 References 277 Chapter 6 Holistic Management of Pain 285 Fran Worboys and Alison Hopkins The Pain Experience 285 Theories of Pain 287 Causes of Pain 292 Types of Pain 293 Pain Cycles: Never- Ending Pain 295 Impact of Pain on People’s Lives 296 Causes of Pain 296 Pain Management Solutions: Assessment 298 Managing Pain 303 Conclusion 312 References 312 Chapter 7 Personalised Care in Leg Ulceration 318 Alison Hopkins and Charlotte Smith The Wider or Social Determinants of Health 319 Wider Determinants of Engagement with Treatment 324 Making Effective Change 326 What Influences Practitioners’ Decision-Making in Leg Ulcer Management? 329 The influence of Confidence, Courage and Competence 330 A Problematic Culture Within Leg Ulcer Management 332 Challenging Non- compliance 335 Understanding the Lived Experience 338 Support Personal Health Management Through Patient Activation 339 Patient Activation Measure 340 Shared Decision- Making 340 Social Prescribing 342 Motivational Interviewing 342 Supporting Self- Management 343 Legs Matter Coalition: Raising Awareness of Lower Limb Conditions 345 Peer Support Groups 345 Using Positive Language to Promote a Positive Culture 346 Conclusion 347 References 348 Chapter 8 Clinical Management of the Lower Limb 353 Georgina Ritchie The Case for Early Intervention 360 Clinical Management 360 What Is Compression Therapy and How Does it Work? 372 Anti- inflammatory Action of Compression Therapy 381 Cautions and Contraindications 384 Considering and Commencing Treatment 386 Location of the Ulceration 396 Compression of the Foot 396 Intermittent Pneumatic Compression 397 Wound Bed Preparation and Clinical Management 398 Conclusion 400 References 400 Chapter 9 Lifelong Management 405 Jane Harry Factors Influencing Venous Ulcer Recurrence 407 Holistic Reassessment Including Ankle Brachial Pressure Index 409 Endovenous Ablation 411 Compression Therapy Systems 411 Assessing for Compression Hosiery 413 Choosing and Prescribing Hosiery 415 Other Considerations when Choosing a Compression Therapy System 423 Empowering Patients’ Self- Management for Leg Ulcer Prevention 434 Knowledge, Staff and Training 439 Public Health 441 Patient Satisfaction and Quality of Life 450 Leg Ulcer Pathways 450 Conclusion 451 References 452 Index 457
Aby Mitchell, Senior Lecturer in Nurse Education, Adult Nursing Department, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London. Aby’s clinical experience spans across burns and plastics, primary care, and physical health in community mental health. Aby is a registered specialist practitioner in district nursing and has an MSc in Advanced Practice (healthcare education). Aby is committed to improving patient care through nurse education. Georgina Ritchie, Executive Director and Director of Education at Accelerate. Georgina brings over two decades of experience in clinical practice and education. Her journey from military nursing in the British Army to leadership roles in the NHS and academia has honed her expertise in community and district nursing. Georgina is a registered community specialist practitioner and a V300 non-medical prescriber, holding an MEd, with a passion for empowering confident clinical practice through education. Alison Hopkins MBE, Executive Director and CEO at Accelerate. With over three decades of experience in wound care, Alison established the leg ulcer service at Tower Hamlet’s District Nursing Service in 1989, beginning a life-long passion for compression therapy and community transformation. In 2019 Alison was awarded an MBE for services to nursing and wound care and holds an MSc in Psychology and Health. In addition to overseeing Accelerate, she continues to contribute to academic journals, and speak at conferences, always seeking to challenge the status quo so that excellent wound and lymphoedema care becomes the norm.
