Leg ulcer update

21/11/11 | Leg ulcers | Alison Hopkins, Anthony Comerota, Agneta Bergsten

Leg ulcer update Wounds International clinical updates present clinical developments in the field of leg ulcers, pressure ulcers, skin integrity and diabetic foot, including the latest from associations, clinicians and industry. If you use an innovative technique in your practice that you would like us to feature in future issues, please email the editor at: scalne@woundsinternational.com

Special strapping for retro malleolal ulcers
This report describes the development of a novel compression technique which has shown a dramatic reduction in leg ulcer prevalence rates.

Venous ulceration creates an enormous economic burden in many countries across the world. This is primarily due to the chronicity of these ulcers, the nursing time required to manage them, the dressing and bandage costs, and of course the poor quality of life, which has been eloquently described in a variety of qualitative studies[1].

Our team based at the East London wound healing centre in the UK has recently described an innovative approach to compression therapy[2]. The premise is that often the most complex or chronic venous ulcers are not positioned in the traditional gaiter site, but in the retro malleolal area [Fig 1]. It is our belief that traditional high compression therapy does not adequately compress in this area, contributing to non-healing.
We have, therefore, developed a strapping technique using cohesive inelastic bandages, which focusses compression around the ankle, foot and retro-malleolal fossa. The full technique has been well described in a recent paper, detailing how we have improved the development of the technique over several years[2].

As a specialist team we have many patients with complex non-healing ulcers referred to us from outside our catchment area. These patients often have large, painful, longstanding and debilitating ulcers. Through case review we have been able to demonstrate the efficacy of the strapping regime, which is a transferable technique that is able to transform lives.

 

 

The leg ulcer prevalence rate in our area has reduced dramatically since the introduction of the technique and on audit was found to be 0.14 per 1000 patients[3], less than half the expected rate. The team presented the prevalence data at the 2011 European Wound Management Association (EWMA) conference in Brussels.

In the absence of a randomised controlled trial, these prevalence figures have to be analysed within the context of the type of service we provide, namely a specialist service of 15 years' duration, which has an experienced team.
The trust and general medical practitioners involved have invested heavily into the service, enabling early specialist intervention and a zero tolerance of all non-healing wounds. In addition, community nurses are accompanied on visits to patients' homes or clinics by specialist nurses. The team is multidisciplinary and includes a dermatologist and a specialist podiatrist. We also focus on the impact of poor gait and the role of ankle exercise in this group.

It is likely that the complete package we provide, including pain management, the focus on improving ankle mobility, as well as the strapping technique, all contribute to improved patient outcomes. However, we believe the improvements in outcome are primarily down to the strapping technique and would welcome a comprehensive study to demonstrate this.

Alison Hopkins is a Head of Service, East London Wound Healing Centre

  1. Ebbeskog B, Emami A (2005) Older patients' experience of dressing changes on venous leg ulcers: more than just a docile patient. J Clin Nurs 14, 10, 1223-1231
  2. Hopkins A, Worboys F, Bull R, Farrelly I. Compression strapping: the development of a novel compression technique to enhance compression therapy and healing for 'hard to heal' leg ulcers. Int Wound J 2011; 8: 474-83.
  3. Hopkins A, Worboys F. The results of a comprehensive wound audit in a UK Primary Care Trust. Presented at EWMA, Brussels, 2011.