Saturday, February 4, 2023

Method For Cleaning Leg Ulcers

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Venous Hypertension / Insufficiency

Cleaning the wound and surrounding skin

The most common cause of poor healing on the lower leg is venous hypertension. You may also hear it referred to as venous insufficiency, venous reflux or venous disease. Venous means anything related to our veins. Blood is pumped from our heart to the rest of our body through our arteries and returns to our heart through our veins. It is then propelled back to our heart by our heart pumping. Our leg and foot muscles help this along by circulating blood as we walk and move our ankles. This is why standing a lot or sitting with our legs down for long periods may stop a wound from healing.

Our veins contain one-way valves to stop the blood falling back towards your feet. These valves can become weak or damaged. When this happens, our veins become so swollen that blood is forced into the tissue of your skin. This makes our skin swollen, fragile and unable to heal as normal.

You might also notice that your ankles are swollen, that there is brown staining on your legs or that your wound is leaking.

To help our veins work better and to control any swelling, compression therapy is an essential part of any treatment plan.

Ten Top Tips On Leg Ulcers

  • Always perform a thorough assessmentAsk about symptoms and how long the patient has had problems. Examine the lower legs. Most patients should have a Doppler ultrasound to calculate the ankle brachial pressure index to see if there are problems with blood supply to the lower leg. This test should be undertaken as early as possible but certainly within a few weeks of the patients first appointment.
  • Use compression to treat venous hypertension and lymphoedemaIf the leg ulcer is because of poor venous return or lymphoedema and the patient has an adequate blood supply to their lower limb, graduated compression therapy is likely to be a very efficient healing method. It is best to think of compression in terms of dose. The recommended dose delivers 40mmHg at the ankle. Compression that delivers less than this will usually be less effective in promoting healing.
  • Always involve the patient when deciding on the best type of compressionIf a patients wound is not too wet they may prefer compression hosiery to bandaging. But if their legs are tender, bandaging might be more comfortable. Including the patient in the decision-making increases the chance of them coping better with their compression therapy.
  • Tell patients to regularly wash their legs and feet and use moisturiserIt is important to maintain good hygiene of both the leg and foot to reduce the risk of infection. Regular use of bland moisturising creams and ointments will protect the skin and its elasticity.
  • Signs And Symptoms Of Leg Ulcers

    The most common symptoms that accompany leg ulcers are as follows:

    • Swelling of the ankles
    • Irritated or flaky skin
    • Skin begins to harden and scale around the ulcers

    These symptoms often vary in their severity. Although most leg ulcers usually disappear in a few days, some may be non-healing. It is always better to try and heal leg ulcers as soon as you can to prevent further complications. For that, you need to diagnose them first. The following are a few most common techniques used to diagnose leg ulcers.

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    How The Intervention Might Work

    Compression bandaging is the gold standard for the management of ambulatory people with venous leg ulceration. Compression bandaging attempts to reverse the effects of venous insufficiency and the evidence suggests that there is an increased rate of wound healing using compression therapy . However, before application of the compression bandaging, it may be important to ensure the wound bed is free from contaminants and devitalised tissue, and wound cleansing could be central to achieving this . It has been suggested that failure to cleanse the wound bed sufficiently may lead to delayed healing, attributed to a number of important factors, including the presence of foreign bodies, necrotic or sloughy tissue and bacterial burden or biofilm and attached to the wound bed) . It is suggested that these factors lead to the increased production of metalloproteases within the wound . These enzymes are produced during wound healing, but when present for prolonged periods or in excess amounts, metalloproteases may become detrimental to healing tissue . Wound cleansing in the form of swabbing, irrigation, or washing the wound bed may contribute to reducing or eliminating some of these factors, thereby enhancing wound healing potential.

    When To Seek Medical Care

    Leg Ulcers
  • 1See your doctor if you have a leg sore that doesnât heal in 2-3 weeks.Most wounds heal or improve on their own within a few weeks. If you have a sore on your leg that doesnât show signs of healing in that time, call your doctor. They can determine what type of ulcer you have and what might be causing it.XTrustworthy SourceCleveland ClinicEducational website from one of the world’s leading hospitalsGo to source
  • Other symptoms of leg ulcers include itching, redness, swelling, and fluid leaking from the wound.
  • The affected leg may also feel heavy, achy, or tight.
  • 2Get medical attention if your symptoms get worse. If your ulcer isnât healing even with medical care, or if you notice your symptoms changing or getting worse, call your doctor right away. You may have a secondary infection in the wound, and youâll probably need to treat it with medication. Common signs of infection include:XTrustworthy SourceMedlinePlusCollection of medical information sourced from the US National Library of MedicineGo to source
  • Worsening redness, swelling, pain, or warmth around the wound
  • Pus, blood, or yellowish or cloudy fluid coming from the wound
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    What Is A Venous Skin Ulcer

    A skin ulcer is a type of wound that develops on the skin. A venous skin ulcer is a shallow wound that occurs when the leg veins donât return blood back toward the heart the way they should. This is called venous insufficiency.

    These ulcers usually form on the sides of the lower leg, above the ankle and below the calf.

    Venous skin ulcers are slow to heal and often come back if you donât take steps to prevent them.

    A venous skin ulcer is also called a stasis leg ulcer.

    The Traditional Idea Of Treating Leg Ulcers With Dressings And Compression Heal Venous Leg Ulcers But Do Not Cure Them

    Prof Mark Whiteley explained that dressings, or even fads such as Manuka honey or sugar, can be useful for skin wounds. Also, compression can be useful for venous leg ulcers. However, no dressing or compression can cure a venous leg ulcer permanent.

    The reason for this is quite simple. As it is the hidden varicose veins that cause the venous leg ulcer, the ulcer cannot be cured until this underlying problem is fixed. No matter what is placed on the surface, the underlying problem remains. Hence the ulcer will recur when the dressings or bandages are removed.

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    Healthcare Advice For Leg Ulcers

    There are some lifestyle changes you can make that will help boost healing:

    • Maintain a healthy weight
    • Eat a well-balanced diet that includes 5 portions of fruit and vegetables a day and protein rich foods such as eggs, fish, chicken or pulses
    • Take light to moderate exercise such as cycling or walking for about thirty minutes at least three times a week
    • Avoid standing or sitting for long periods of time
    • Put your feet up elevate your legs above your heart.
    • Every so often, move your feet around in circles, then up and down. This helps blood circulate and get back to your heart

    Symptoms Of Leg Ulcers

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    • that they are commonly found on the lower leg and ankle
    • a sunken, asymmetrically shaped wound
    • the edges of the ulcer are clearly defined from the surrounding skin
    • the surrounding skin is intact, but inflamed
    • the surrounding skin may be pigmented, hardened or calloused
    • yellowish-white exudate
    • varicose veins in the leg.

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    What Is The Best Way To Heal A Leg Ulcer

    Latest research confirms that the fastest way to heal the commonest type of leg ulcer is Early endovenous ablation of superficial venous reflux, in addition to compression therapy and wound dressings.

    This method reduces the time to healing of venous leg ulcers, increases ulcer-free time and is highly likely to be cost-effective .

    What Is A Leg Ulcer

    A leg ulcer describes a break in the skin, which allows air and bacteria to get into the leg. This is often caused by an injury, usually a minor one that cuts or grazes the skin.

    In healthy people such an injury heals up quickly within a week or two. However, if the person has an underlying health problem, the skin does not heal and the area of breakdown can increase in size. This is what is meant by the term chronic leg ulcer.

    All leg ulcers are a problem because they cause pain, disability and social isolation. In younger people, they can lead to time off work and sometimes loss of employment. All leg ulcers should be referred to a specialist team for assessment and treatment if they do not heal within 2 weeks.

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    Venous Leg Ulcers: 6 Things To Know When Treating Venous Disease

    Lower extremity venous disease affects millions of Americans and may ultimately lead to open, draining wounds that adversely affect quality of life. However, there are exciting developments in early diagnosis, prevention and treatment of venous leg ulcers . On the treatment side, there are more choices now than ever before in compression products, which is greatly improving the patient experience. But proper treatment also comes from a better understanding of venous leg ulcers, and better understanding comes from more education. Luckily, were here to help provide education and support for you and your team, so here are six things to know when treating VLUs.

    Other Treatments For Venous Leg Ulcers

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    Cochrane Reviews of several other treatments have highlighted large gaps in the evidence.

    The Cochrane Review Therapeutic ultrasound for venous leg ulcers found that it is unclear whether therapeutic ultrasound improves ulcer healing and the review authors say that any effect is likely to be small. There is a Cochrane Clinical Answer on this review: For people with venous leg ulcers, how does therapeutic ultrasound affect outcomes?

    The authors of the Cochrane Review Electromagnetic therapy for treating venous leg ulcers concluded that It is not clear whether electromagnetic therapy influences the rateThe speed or frequency of occurrence of an event, usually expressed with respect to time. For instance, a mortality rate might be the number of deaths per year, per 100,000 people. of healing of venous leg ulcers.

    The role of Subfascial endoscopic perforator surgery for treating venous leg ulcers also remains uncertain.

    There were no randomisedRandomization is the process of randomly dividing into groups the people taking part in a trial. One group will be given the intervention being tested and compared with a group which does not receive the intervention . trials meeting the criteria for inclusion in the Cochrane Review Extracorporeal shock wave therapy for the healing and management of venous leg ulcers .

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    Does Cleaning Venous Leg Ulcers Help Them To Heal

    Background

    Leg ulcers are open skin wounds that develop below the knee, usually because blood flow is poor in the lower leg. This can occur because of blockages, for example when small blood clots form in the veins. It can also happen when the valves in the veins that prevent blood from flowing backwards stop working properly. Poor blood flow damages the skin and tissue, and creates venous leg ulcers.

    Ulcers are unsightly and may become painful or infected. On average, ulcers take from six to nine months to heal. However, some ulcers can take years to heal, and a small number never do. Once ulcers have healed, they can reoccur.

    The main treatment for venous leg ulcers is to use bandages or stockings that compress the leg , to increase blood flow in the veins. It is also thought to be important to clean the wound. Different types of cleaning solutions can be used, including: normal saline water antiseptics detergents or disinfectants .

    Cleaning solutions can be applied to the ulcer using a swab , a syringe with a needle, or a spray canister. Ulcers can also be bathed in the cleaning solution, using a basin or bucket, or during a shower. Cleaning can cause discomfort, and may be painful.

    What did we want to find out?

    We wanted to find out:

    – whether cleaning venous leg ulcers helps them to become smaller and heal

    – whether some cleaning solutions, or methods of applying solutions, are more effective than others

    – how much cleaning wounds costs and

    Our methods

    Treating The Ulcer Medically

  • 1Visit your doctor to get information about your ulcer. Treatment for an ulcer depends on whether it is an arterial ulcer or a venous ulcer . Treating an arterial ulcer is often a matter of urgency. So it is important to first call your doctor and get their professional advice before trying to heal an ulcer on your own.XResearch source
  • Your doctor will first examine the wound and then take blood pressure readings at the ankle and arm to measure the blood flow in your lower leg.XResearch source
  • Venous leg ulcers are more common than arterial ulcers, making up over 90% of all cases.XTrustworthy SourceJohns Hopkins MedicineOfficial resource database of the world-leading Johns Hopkins HospitalGo to source
  • 2Consider surgery to treat an arterial leg ulcer. A blocked or narrowed artery is the most common cause of an arterial leg ulcer. This blockage reduces the amount of blood that can flow to tissue in your leg. Poor blood flow can deprive the tissue of oxygen and nutrients, possibly leading to the death of the tissue. For this reason, treating an arterial leg ulcer is an urgent matter.XResearch source
  • Your doctor may refer you to a vascular surgeon who may perform surgery either to clear out the blocked artery or to add a new route for blood to flow along and bypass the blockage.
  • While your external wound may heal in as little as 2 weeks after the surgery, it may take several months for the underlying tissues to fully heal.XResearch source
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    Description Of The Intervention

    For the purposes of this review, we define wound cleansing as the use of fluid to remove loose debris and devitalised tissue from the wound surface . It is suggested that wound cleansing is an intrinsic element of wound management. It is performed to remove surface contaminants, bacteria, nonviable tissue and excess exudate from the wound bed and surrounding skin , thus establishing an environment conducive to wound healing . Cleansing is thought to be an effective way to remove inflammatory stimulants and local barriers to wound healing from the wound bed , with the aim of aiding health . However, unnecessary or inappropriate cleansing may lead to trauma to the wound bed by damaging fragile granulating or epithelialising tissue . Therefore, the aim of cleansing and the method chosen must be carefully considered to maximise the action and minimise any harm to the individual .

    Wound cleansing comprises three elements: technique, solution, and equipment . Techniques includes swabbing, irrigation and bathing.

    The equipment needed for wound cleansing will depend on the technique chosen, for example a needle and syringe for irrigation, or a bucket or a shower for bathing .

    Apligraf: A Biomaterial For Wound Healing/human Skin Equivalent68

    How to Cure Venous Leg Ulcers Mark Whiteley

    Apligraf is a new tissue engineered skin product cultured from human dermal fibroblasts and keratinocytes. Histologically it resembles a simplified version of skin. When applied, Apligraf seems to react to factors in the wound and may interact with the patient’s own cells to stimulate the production of growth factors. It is being extensively studied in diabetic ulcers, clean excision wounds, and burns. Human skin equivalent appeared to promote wound healing in three ways: apparent graft take, temporary wound closure, and stimulation of host healing by acting as a biological dressing. The efficacy of human skin equivalent suggests that it will prove useful for promoting the healing of venous ulcers.

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    Treatment What Treatment Will I Be Offered For My Leg Ulcer

    Compression therapy

    If your wound isnt healing because of venous hypertension and there are no problems with the blood supply to your legs, then you should be offered compression therapy.

    Compression therapy improves blood supply by applying pressure to the leg. This can be done by bandaging the lower leg or by wearing supportive socks, stockings or tights. Compression therapy is very effective at reducing swelling, improving blood flow in the veins and healing or preventing sores or ulcers.

    There are lots of different types of compression therapy so ask your nurse to find something that is right for you.

    Compression can be a little uncomfortable when you first start treatment but should not cause you any pain. Any discomfort should reduce as the swelling goes down. If you do experience discomfort, talk to your nurse or doctor about it and they will advise you on ways of alleviating this.

    In addition to the compression, your nurse should also advise you on wound care and dressings to keep your wound healthy.

    Diagnosis Of Leg Ulcers

    • examine the wound
    • perform some tests to measure the blood flow in your lower leg, such as the ankle-brachial index. This test compares blood pressure readings taken at the ankle and at the arm using a device called a Doppler machine
    • recommend an angiogram for an arterial ulcer, to find out if the artery needs surgery to clear the blockage.

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