It’s important that you continually update and learn new skills during your working practice as a nurse or health care assistant. Ongoing training is not only important for CPD needs, but it’s also beneficial for the welfare of your patients. One vital part of training for all health care staff is that of tissue viability and in particular leg ulcer care. Below we explore the definition of a leg ulcer, the causes, venous disease, treatment options and other interventions and support…

What exactly is a leg ulcer?

In simple terms, this just means a skin break that is located on the leg. As a result of this break, bacteria can then enter any underlying tissue. If you are active, fit and healthy, then this type of skin injury will heal by itself, usually in less than a week. However, if you are diabetic, elderly, or you have reduced or limited mobility, then further breakdown of the skin can occur, which can then result in a chronic leg ulcer.

What is the cause of leg ulcers?

There are several causes of leg ulcers, the most common being venous disease. In fact, around 80% of all leg ulcers are caused by venous ulcers. This is when the veins in the legs are not functioning as they should. Other causes include arterial disease, when the arteries in the leg are weakened or damaged, and rheumatoid arthritis and diabetes, both of which affect blood flow and tissue viability.

The link between venous disease and ulcers?

So, why does venous disease cause leg ulcers? Well, it is these veins that transport blood from the foot back up to your heart. They are very effective in directing blood the right way around the body due to the single valve that prevents blood from travelling back down the leg. Problems occur when this valve becomes damaged or weakened resulting in blood moving the wrong way. As a direct result, an increase in pressure is created within the vein, which can then lead to skin break down and the formation of leg ulcers.

Treatment options for venous leg ulcers

You have to address both the high pressure in the vein and the leg ulcer itself. This involves pressure stockings or a pressure bandage, dressings, elevating the limb and occasionally surgery. Below we look at these issues in more detail.

Elevating the limb

A good way to reduce the high pressure on the veins is by elevating the leg. Ideally the foot should be elevated above the level of the heart. Using a footstool with a cushion when sitting is a good idea. It’s also advantageous to raise the bottom of the bed so that the leg is elevated while the patient is asleep.

Stockings or a compression bandage

It’s also important to reduce this pressure when the patient or resident in your care is mobile. This can be achieved with the use of a compression bandage or stocking. These are applied in layers and with the right amount of pressure. It is vital that you are fully trained or use the services of a tissue viability nurse to do this task. They often need to be worn even when the ulcer has healed.

The importance of dressings

Leg ulcers need to be kept clean and excess dead skin removed in order for the ulcer to heal. Training is required so that you know how to clean, de-slough the wound and to apply the correct type of dressing, depending on the stage of healing. Dressings are usually changed once a week, although more frequent changes may be needed.

Surgery

Occasionally, surgery is needed when ulcers are particularly large or refuse to heal. This may result in a skin graft, or surgery that repairs the vein. If a patient has varicose veins, then once the ulcer has healed, varicose vein surgery can be carried out.

Does it take a long time for ulcers to heal?

Venous leg ulcers do take on average three to four months to heal. It is a slow healing process. Some ulcers will heal more quickly, some may take longer than six months. Every patient is different. The important thing is that the ulcer is treated correctly and specialist advice sought if complications arise.

Will an ulcer come back?

Many patients think that once the ulcer has healed that they will not reoccur, but the truth is that once they have had a leg ulcer, they are more prone to them. Although the skin will now be healed, the high pressure on the vein will still remain. This is why it is important to inform your patient that they need to use preventative measures.

They should continue wearing compression stockings to help reduce the pressure in the veins. Elevating legs while sitting is a good idea, and it’s important to keep legs moisturised as dry skin is more prone to breaking and becoming infected. Keeping fit and eating well will also help not only with general health, but will keep skin healthy.

How to help your patient during treatment

Treating leg ulcers is a timely process and patients may feel they are restricted and unable to carry out certain activities. Reassurance and support is needed, as well as encouragement to keep active. Even an individual with reduced mobility can move their leg up and down while sitting, encouraging blood flow and circulation, helping the healing process.

It’s also important that those who smoke are encouraged to stop, as this will help the ulcer to heal more quickly. If there is a local support group then encouraging your patient to attend is a good way to gain support.

We offer group and e-learning courses for those who are new to tissue viability care, through to specialist courses. To learn more about the wide range of tissue viability and pressure area care courses available from Caring for Care, that cover leg ulcers, then please do browse our website and get in touch with us today.