Thursday, April 23, 2020

Leg ulcer/wound Important Information

Have you sustained a new wound to your lower leg? Or perhaps have a pre-existing wound that you are worried isn’t improving or is looking/feeling worse? If so, our Practice Nursing team is still here to help you despite coronavirus changing our usual service delivery!
 You don’t need to manage at home alone, unsure how to best care for it.  Perhaps you may worry we are too busy and hence you may be reluctant to seek our advice…but in fact, we want to encourage you to get in touch with us.   Despite the new challenges we face, as always we are still here for you.
Why are we so keen to see your wound? Well, any wound on the lower leg (above the ankle but below the knee) is at risk of becoming a leg ulcer – no matter how minor the trauma and regardless of the cause.  Leg ulcers are not a disease in themselves, they all start as ‘normal’ wounds. When you add together a leg wound, perhaps with underlying health conditions such as high blood pressure or diabetes or issues such as swelling/fluid to the lower legs, and with inappropriate management then it presents the perfect recipe for becoming an ulcer. And the modern definition of an ulcer is a wound on the lower leg (between the ankle and the knee) which remains unhealed for 2 or more weeks.  So: it really is vital that you are proactive to give your wound the best chance of healing and to avoid ulceration. We understand if you are worried about coming down to the surgery at the current time – after a phone consultation with one of us it may be that we can offer you an initial video consultation rather than face to face appointment – so please do let us know should this be the case.

What is a Leg Ulcer?
Most leg ulcers are venous. This means the wound fails to heal because of underlying high blood pressure in the veins of the lower leg. The main cause of this is faulty valves within the leg veins. In healthy leg veins, the valves prevent blood flowing backwards and keep the blood moving forward on its return to the heart. The valves may be faulty at birth, may weaken with age or become damaged following events such as a thrombosis (blood clot) or as a result of lifestyle choices. When the valves are damaged, backflow of blood is not prevented and blood pressure in the veins increases. Persistent high blood pressure can cause fluid to leak out of the veins causing lower leg swelling and/or can damage the tiny blood vessels in the skin. Over time, this can damage the overlying skin. This subsequently increases the risk of leg ulceration as the skin can easily break down resulting in a wound, or after trauma the skin does not heal well.  An ulcer can therefore form. Once an ulcer is present, fluid can leak from it which can cause further breakdown of the surrounding skin. Unless managed appropriately, leg ulcers can deteriorate rapidly. Therefore, it is recommended that you seek medical assessment of your lower leg wound as soon as possible.

Can a venous leg ulcer be cured?
Yes! Healing can take time and is dependent on your general health and skin condition. The sooner you can seek medical assessment and management, the greater the chance you have of ulcer healing. So please be proactive. Most leg ulcers are venous, but some are arterial or ‘mixed’ – resulting from diseased arteries, not just veins.  Arterial and mixed ulcers  are more complex, healing can take longer and may need referral for specialist assessment. Your Nurse can advise you on the likely diagnosis of your wound after assessment. Assessment helps our Nurses guide decisions around the best treatment for your wound to prevent further deterioration and promote healing.

What is the treatment for venous leg ulcers?
Your Nurse will discuss treatment options with you. Treatment will focus on addressing underlying cause of the ulcer, not just dressing the wound. Research has found compression therapy is the most effective treatment for venous leg ulcers. Compression helps to improve the blood flow and blood pressure, and therefore increase healing rate. Engaging with compression therapy therefore results in more ulcers healing and reduces the risk of recurrent future ulceration. Compression therapy may in the form of bandaging, hosiery/socks or wraps. Our Nurses will advise you what may be suitable for you.

What can I do to help my leg wound heal?
Phone us for advice if you are worried   01404 814447
Exercise: Keep mobile and make use of your daily allowed trip outside for exercise (if you are able to and this is safe for you to do as per current government Coronavirus guidance). A daily walk will help. Sitting exercises including raising your heels from the ground, circling your ankles and raising your toes are also great to improve circulation.
Smoking: Try to stop.  Smoking damages veins and arteries so will slow down healing.
Diet: Aim for a healthy balanced diet. Obesity is a risk factor for leg ulceration so if you are overweight, consider how you may be able to attempt weight loss. Additionally, if you are underweight, seek advice online/from your GP/Practice Nurses regarding how you can improve your nutritional intake.
Medication: Continue taking your medication as prescribed.
Skin care: Use a non-perfused moisturiser on any dry skin at least once a day, ideally twice, to improve skin quality and prevent ulceration risk.
Elevation: When resting, keep your legs raised above hip height. This will help reduce swelling and improve circulation.

So please, don’t suffer and worry alone at home, we would love to hear from you and help as soon as possible after your wound occurs/you notice concerns. As always, we are here to help.

Coleridge Medical Centre

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