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<\/p>\nA leg ulcer is defined by the National Wound Care Strategy as ‘an ulcer that originates on or above the malleolus but below the knee that takes more than 2 weeks to heal’.<\/p>\n
There are several reasons why people get leg ulcers, the most common one (approx. 60 \u2013 80%) being due to venous insufficiency arising from faulty valves in the veins and\/ or poor calf muscle pump action.<\/p>\n
A smaller percentage of ulcers (10 \u2013 20%) are caused by poor circulation in the arteries or as a result of other diseases such as diabetes or rheumatoid arthritis.<\/p>\n
<\/p>\n
It is estimated that approximately 1.5% of the adult population in the UK is affected by active leg and foot ulceration, which equates to 730,000 patients (Guest 2019).<\/p>\n
Without correct treatment, ulcers can remain unhealed for many months or sometimes years, resulting in episodes of infection, pain and immobility. The biggest proportion of leg ulceration is due to venous insufficiency.<\/p>\n
However, many ulcers do have a mixed aetiology with elements of arterial disease or chronic oedema which may be further complicated by heart failure.<\/p>\n
The Lower Limb Care pathway is available here Resources – Tissue Viability<\/a>.<\/p>\n This pathway encompasses all aspects of lower limb care, in line with the NWCSP-Leg-Ulcer-Recommendations-v2-1.8.2023<\/a> and the Wounds UK Best Practice Statement – The Use of Compression Therapy for peripheral oedema: Considerations in people with Heart Failure (2023)<\/a><\/p>\n All clinicians delivering leg ulcer care are expected to use this pathway.<\/p>\n Chronic oedema is an umbrella term for swelling that does not respond to elevation or diuretics and which has been present for three months or more. It can occur in the limbs and\/or the trunk, head and neck or genitalia. There are a number of possible causes including;<\/p>\n Left untreated chronic oedema of the lower limbs can progress and cause skin changes such as discolouration, eczema, dry skin plaques and hardening of the tissues (refer to CHROSS checker picture cards below for examples). The risk of developing leg ulcers increases as the tissues become more vulnerable to injury and wounds fail to heal properly. The tissues become prone to infection and can require hospital admission. In the advanced stages the limbs change shape developing skin folds with hard cobblestone skin. They can begin to leak fluid profusely as the skin is unable to contain the fluid.<\/p>\n Chronic oedema can have a significant impact on a person\u2019s quality of life. It is also costly to the health service in terms of time, resources and staffing. The key to managing chronic oedema is early intervention to prevent disease progression. The main interventions include compression therapy, skin care, exercise and elevation. Managing chronic oedema complicated with ulceration, lymphorrhoea (leaky legs) or infection can prove a challenge. However, with appropriate management strategies, these factors can be reduced.<\/p>\n<\/div>\n <\/details>\n Correctly applied compression therapy is recognised as the mainstay of treatment for both the preventative and therapeutic care of venous disease, with high compression bandaging now established as the treatment of choice for venous leg ulceration. Compression therapy is mainly delivered through the application of bandaging or compression hosiery.<\/p>\n Compression therapy aims to reverse the effects of venous hypertension by:<\/p>\n Reduced compression therapy can be applied in the absence of any red flags for compression (please refer to the Lower Limb Care pathway) as part of immediate and necessary care. High compression therapy should not be applied before the arterial status of the limb has been established (by completing a holistic vascular assessment including ABPI) and should be applied in line with local policy and guidelines.<\/p>\n Two-layer hosiery kits, may be considered a suitable first-line therapy for patients with minimal oedema and a regular limb shape. Our formulary product changed in 2024 from Actilymph to kits JOBST UlcerCare Compression Garments | JOBST UK.<\/a> This decision was made as the liner component of the Ulcercare kit delivers mild (up to 20 mmHg) of compression and can be used to provide immediate, necessary care once red flags have been assessed and excluded. The outer stocking provides a further 20 mmHg and can be added following a holistic vascular assessment, where this confirms it is safe to initiate strong (up to 40 mmHg) therapeutic compression. Hosiery kits have also been shown to be a cost-effective alternative to bandaging in appropriate patients. However, they are not suitable for patients with moderate oedema, mishappen limbs or those with very large ulcers or heavily exuding (\u201cwet\u201d) wounds.<\/p>\n Multi-layer compression bandaging systems, such as K-Two kits, provide an alternative for patients with mild-moderate oedema, large or heavily exuding wounds. These systems typically consist of a combination of padding, short-stretch layers, and outer cohesive layers that together deliver sustained therapeutic compression while protecting the skin and accommodating wound dressings.<\/p>\n Patients with moderate oedema and\/or a distorted limb shape are more likely to benefit from short-stretch compression bandaging, such as Clinistretch, which can better contain oedema and accommodate changes in limb contour. Short-stretch bandaging can also be particularly effective for more active patients, as it provides higher working pressure during movement while maintaining lower resting pressure. For video demonstration and application guides, please visit this link: Clinistretch\u00ae Compression Bandaging Guides on Vimeo<\/a>.<\/p>\n Adjustable compression wrap systems may also be considered. However, there is currently insufficient evidence to confirm that they are as effective as established bandaging or hosiery systems for active wound healing. They may be more appropriately used following ulcer healing for ongoing oedema management, or may be considered in cases where traditional bandaging or hosiery kits are contraindicated, not tolerated, or impractical.<\/p>\n For compression garments (post-healing or preventative care), please refer to the following Hosiery Booklet and Hosiery Formulary for guidance on the selection and application of compression hosiery in Oxfordshire:<\/p>\n <\/p>\n<\/div>\n <\/details>\n <\/p>\n Leg Ulcers A leg ulcer is defined by the National Wound Care Strategy as ‘an ulcer that originates on or…<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":23,"menu_order":3,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"class_list":["post-53","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/oxfordhealth.nhs.uk\/tissue-viability\/wp-json\/wp\/v2\/pages\/53","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/oxfordhealth.nhs.uk\/tissue-viability\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/oxfordhealth.nhs.uk\/tissue-viability\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/oxfordhealth.nhs.uk\/tissue-viability\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/oxfordhealth.nhs.uk\/tissue-viability\/wp-json\/wp\/v2\/comments?post=53"}],"version-history":[{"count":23,"href":"https:\/\/oxfordhealth.nhs.uk\/tissue-viability\/wp-json\/wp\/v2\/pages\/53\/revisions"}],"predecessor-version":[{"id":525,"href":"https:\/\/oxfordhealth.nhs.uk\/tissue-viability\/wp-json\/wp\/v2\/pages\/53\/revisions\/525"}],"up":[{"embeddable":true,"href":"https:\/\/oxfordhealth.nhs.uk\/tissue-viability\/wp-json\/wp\/v2\/pages\/23"}],"wp:attachment":[{"href":"https:\/\/oxfordhealth.nhs.uk\/tissue-viability\/wp-json\/wp\/v2\/media?parent=53"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}\n \n Chronic Oedema<\/span>\n <\/summary>\n
\n![\"14](\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/2015\/08\/14-Chronic-oedema.jpg\")
<\/p>\nChronic Oedema<\/h2>\n
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\n \n Compression therapy<\/span>\n <\/summary>\n
![\"Actico](\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/2015\/08\/Actico-Rosidal-app5_2014.jpg\")
<\/a><\/p>\nCompression Therapy<\/h2>\n
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![\"\"](\"https:\/\/oxfordhealth.nhs.uk\/wp-content\/uploads\/2022\/01\/ds-300x224.jpg\")
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