SIGN Guideline 120: Management of chronic venous leg ulcers

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7 Provision of information

This section reflects the issues likely to be of most concern to patients and their carers. These points are provided for use by health professionals in their discussions with patients and carers and in guiding the production of locally produced information materials.

7.1 CHECKLIST FOR PROVISION OF INFORMATION

Assessment
  • Explain to patients that the ABPI test will be carried out to decide if compression treatment is appropriate.
  • Advise patients who experience pain in their calf when walking that this may be an indication of arterial disease and may affect their treatment options.
  • Explain to patients that taking a swab from the ulcer to look for bacteria is not usually helpful, as most leg ulcers have bacteria which do not delay healing.
  • Advise patients that it may be useful to take a swab if the ulcer becomes more painful or there are signs of infection.

Treatment
  • Explain the results of the ABPI test and any swab tests to patients.
  • Explain to patients that compression treatment with bandages or with a stocking is the single most important treatment for a leg ulcer, and is far more important than the ulcer dressing.
  • Ensure that patients are aware of the need for a weekly change of bandage and that more frequent changes may be required in certain circumstances.
  • Encourage patients to wash their leg gently in warm tap water when bandages are being changed.
  • Advise patients that antibiotic tablets are only needed very occasionally.
  • Explain to patients that they may be offered pentoxifylline tablets to help improve their blood flow which may help their leg ulcer to heal.
  • The following advice should be offered to patients and carers during treatment of leg ulcers:
    • regular ankle/calf exercises may be of value
    • when resting try to keep the ankles up higher than the heart
    • raising the foot of their bed at night if tolerable will help to assist venous return
    • it is important to maintain a normal sleeping pattern in bed rather than in a chair
    • waterproof protectors for bathing/showering are available.
  • Explain to patients that skin irritation (dermatitis) near or around the leg ulcer may be due to leaky veins, but occasionally may be due to the treatments being used. Referral to a specialist for assessment and possible patch-testing may be required. The following advice should be offered to patients:
    • use emollients to help keep the skin supple
    • avoid perfumed soaps
    • dry the leg carefully
    • avoid trauma.
  • Explain to patients that leg ulcers can sometimes cause pain. If pain is experienced, advice should be sought from their GP or district nurse.
  • Advise patients that they may be referred to a specialist if their ulcer is not responding to treatment or if there are features which require investigation.
  • Inform patients who have a long-standing leg ulcer that it may have to be reassessed. This might involve a sample (biopsy) of the ulcer being taken for microscopic analysis.

Prevention of recurrence
  • Emphasise to patients that compression stockings are available on prescription and ensure they are aware of the importance of wearing well fitting compression stockings during the day once the leg ulcer has healed. Advise them that these are known to improve considerably the chances of the leg remaining healed and are well worth any inconvenience.
  • Explain to patients that there might be the possibility of surgical treatments to prevent ulcer recurrence, but that this is not suitable for everyone.
  • Explain to the patients about:
    • the benefits of exercise
    • the need to wear compression hosiery from the time you get up in the morning until going to bed at night
    • renewing hosiery every 3-6 months
    • keeping mobile
    • elevating their legs when resting
    • showering as normal
    • using emollients.

7.2 SOURCES OF FURTHER INFORMATION

Leg Ulcer Forum Scotland (LUFS)
PO Box 641, Huntingdon, PE29 9GU
Tel: 01480 412381
www.legulcerforum.org

Affiliated to the Leg Ulcer Forum UK, this forum provides educational materials and runs local and national educational events. The committee of the forum represents the different models of care that are available in Scotland.

Lindsay Leg Club
PO Box 689, Ipswich, IP1 9BN
Tel: 01473 749565
www.legclub.org

The Lindsay Leg Club Foundation exists to help patients alleviate suffering and stigma caused by leg ulcers. Leg Clubs aim to provide leg ulcer management in a social environment, where patients (members) are treated collectively and the emphasis is on social interaction, participation, empathy and peer support where positive health beliefs are promoted.

There is a Leg Club in Scotland for patients in Speyside and information can be provided to patients in other areas of Scotland.

7.3 SAMPLE INFORMATION LEAFLET

An example information leaflet for patients with venous leg ulcer is given below. Healthcare professionals may wish to adapt this for use in their own departments, and insert relevant local details.

What is a venous leg ulcer?

A leg ulcer is an area of damaged skin where the tissue underneath is exposed. Leg ulcers develop when there is poor blood circulation in the veins of your legs. In healthy leg veins, blood pressure is kept at the right level by the valves in your veins. These valves prevent blood from flowing backwards and keep blood moving through your veins. When the valves become damaged, the blood pressure in the veins of your legs will rise. This causes fluid to leak out of them leading to swelling, irritation, tenderness and eventually the formation of an ulcer.

What is the treatment for leg ulcers?

Compression bandaging is the most effective treatment for venous leg ulcer.

The bandages work by helping push the blood in your leg veins back up to your heart.

The type of bandage you wear will be decided by your health care professional following discussion with you. Different strengths are available and your healthcare professional will help select the best one for you – aiming to find the strongest that you are able to wear.

A dressing is worn under the bandage. This will be changed when required, usually once a week, by your healthcare professional. When the dressing is changed, you should take the opportunity to gently wash your leg in warm tap water. Waterproof protectors are available for bathing/showering at home between dressing changes.

Elevation (raising your legs)

When resting, you should try to keep your ankles up higher than your heart. This allows the fluid to drain from your legs.

At night time it is important that you keep to your normal sleeping habits – you should sleep in your bed rather than in a chair. Raising the foot of your bed at night may also help.

Exercise

You should keep mobile and continue with your everyday activities. Taking a walk each day can help. You should avoid standing still but if you have to stand you could exercise on the spot by moving your toes inside your shoes. You can also do some exercises when you are sitting, for example you can rotate your ankles and bend your toes towards you then away from you.

Moisturising

Dry scaly skin needs to be treated with a non-perfumed moisturiser (emollient) to keep the skin moist. If you have been prescribed a moisturiser, you should use it as often as possible, ideally once or twice a day. You should also avoid perfumed soaps and dry your legs carefully to prevent irritation.

Skin irritation (dermatitis) near a leg ulcer is usually caused by the leaky veins, but may sometimes be due to treatments such as creams, dressings and bandages. You may need to be referred to a dermatologist (skin-care specialist) who may investigate this by doing skin patch tests.

Are leg ulcers painful?

You may or may not experience pain from your leg ulcer. If you do have pain and it prevents you from carrying out your normal daily activities, you should speak to your GP, district nurse or healthcare professional about this.

How should I care for my legs once my leg ulcer has healed?

Venous leg ulcers result from a chronic condition of the veins and even when they have been treated successfully are likely to return. You can help to prevent this by wearing compression stockings.

Compression stockings apply constant pressure to your leg to improve the circulation through your veins and can help prevent the ulcer returning. It is important that you put your stockings on first thing in the morning and remove them before going to bed at night. Applicators to help you apply the stocking are available on prescription. You should talk to your GP or district nurse for advice on applicators.

There are a number of other things you can do to stop your leg ulcers from coming back again:

When should I seek help?

You must tell your healthcare professional if you have any of the following problems:

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Last modified 27/02/12 © SIGN 2001-2012

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