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Introduction:

This essay is a part of the study of nursing practices in chronic Wound Management based on venous
leg ulcers. The essay covers the various aspects of this particular medical condition, its symptoms,
causes, aftereffects, various treatment therapies in the UK and costs incurred by NHS every year in
treating Venous Leg Ulcers. The study begins with an introduction to the Venous Leg Ulcer, its
definition, symptoms, percentage of prevalence in the United Kingdom and is intended to obtain an
insight to efficient wound management practices.

Venous Leg Ulcers:


Definition:

According to the information provided by the NHS on Venous leg ulcers, a leg ulcer is an area of
damaged skin below the knee on your leg or foot that takes longer than six weeks to heal. The most
common type of leg ulcer is a venous leg ulcer, accounting for 80-85% of all cases, costly to treat,
and respond best to early diagnosis and treatment.

When veins in one’s legs do not work properly it is termed venous insufficiency and leads to venous
leg ulcers and are attributable to the major risk factors like diabetics, obesity, family history and
lifestyle. Venous leg ulcers are more popular among the elderly compared to the youth. And as
Myers (2004, p.230) points out that ‘women are three times more likely than men to have a venous
insufficiency ulcer’. One of the major implications of Venous leg Ulcer is that it is a chronic wound
with poor healing system and chances are high for a recurrence.

Symptoms:

The main symptoms of a venous leg ulcer are itching, swelling, eczema, aching, pain, oedema, and
varicose veins.

Management of the Wound:


According to Vow den (2010), there are four phases to effective leg ulcer management: assessment,
treatment, review of progress and management of the healed ulcer. [4] Hartmann (2008) says
venous leg ulcer is a chronic wound with a poor or absent healing tendency and that chronic wounds
like venous leg ulcer also heal in a phase-specific manner. Regardless of the type of wound and the
extent of tissue loss, every wound healing process proceeds in phases which overlap in time and
cannot be separated from each other. In practice, the three phases of wound healing are known for
short as the cleansing, granulation, and epithelisation phase. [5]

Diagnosis:

According to Hartmann (2008, p.16) an exact diagnosis is essential since ‘about 90 % of leg ulcers
develop as a result of venous hypertension secondary to severe chronic venous insufficiency and
about 6 % of the venous leg ulcers are attributable to reduced peripheral arterial blood supply and
about 4 % to specific skin diseases. This requires taking a detailed medical history, a clinical and
instrumental examination and differential diagnostic procedures to rule out non-venous
osteopathological factors.’ [6]

Doppler studies:

Doppler study is a test carried out to confirm a diagnosis of venous leg ulcer conducted on both of
the patient’s legs to check for arterial insufficiency (high blood pressure due to poor blood flow).
Like venous insufficiency, arterial insufficiency refers to blood not flowing properly through your
arteries. Signs of arterial insufficiency include hair loss in the affected area and the skin in the
affected area being pale and cold to the touch. [7] However, there are some conditions like diabetes,
atherosclerosis, systemic vasculitis, rheumatoid arthritis etc that can make the results of Doppler
studies unreliable in which case a specialized treatment is required. [8] As per Hartmann Medical
Edition (2008), the only technique which can provide further diagnostic information in this situation
is acral oscillography or possibly colour duplex sonography. [9]

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