Treating Your Venous Leg Ulcer

1. Treating your Venous Leg Ulcer This leaflet contains guidance for patients with venous leg ulcers www.buckshealthcare.nhs.uk Follow us on Twitter @buckshealthcare If you require a translation of this leaflet please call 01296 316042 Sarah Mobsby March 2016 March 2018 Vasc1 2

2. What is a Venous Leg Ulcer? A venous leg ulcer is an area of skin that has broken down, usually just above the ankle. This can happen spontaneously or through injury, but then it fails to heal. When there is an underlying problem, the skin does not heal and the ulcer can even increase in size if left untreated. Blood Flow You may have heard your doctor or nurse talking about arteries and veins. Arteries are the blood vessels (tubes) that carry blood from your heart to your body. The blood in the arteries is full of oxygen. When this blood had been used and the oxygen taken out of it, veins are the tubes that bring this used blood back to the heart and lungs. This happens continuously. If you just think about your legs, the arteries are the tubes carrying the blood down your legs to your toes and the veins are the tubes that bring the blood back up to your body. • Long term advice • Whether your leg ulcer has healed or is still healing, remember: • Compression is important to keep the pressure down in the veins, so keep your bandages on and when healed, wear your compression hosiery daily. • Elevate your legs whenever possible but keep up your normal activity. • Keep the skin in good condition, moisturise regularly with a good emollient. If you are wearing hosiery, moisturise your leg at night, not just before you put your hosiery on! • Weight loss, exercise, eating a healthy diet and stopping smoking can all contribute to having healthy legs! 2 11

3. Stopping the ulcer from coming back once it has healed • Venous leg ulcers commonly come back after they have healed, if the high pressure within the veins is allowed to come back. Therefore, once your ulcer has healed, your nurse may continue to bandage your leg for a few more weeks and then will fit you with a good pair of compression socks or hosiery. If hosiery was used to heal your ulcer, you will need to continue with this although the compression level may be reassessed. • You will be given two stockings for your leg, so that you can wear one and have one in the wash. • It is important that you wear the compression hosiery to stop your ulcer coming back. • The compression stockings should be replaced with new ones every 6 months as they can wear out. • Take good care of your skin, stay active and if relaxing at home, still put your feet up when you can. What causes a Venous Leg Ulcer? The veins in your legs have one-way valves that make sure your blood flows up your legs and not down. In some people these valves are not very effective or have been damaged and are not working properly. If this is the case, the blood can flow the wrong way down the veins which results in high pressure in the veins when you are standing up or sitting with your legs down. This abnormally high pressure within the veins damages the skin and can lead to leg ulcers developing. 10 3

4. How is a Venous Leg Ulcer diagnosed? • The appearance of a venous leg ulcer is usually fairly typical, the skin and ulcer look different to ulcers caused by other problems such as poor circulation in the arteries or nerve problems. • To rule out poor circulation as the cause of your ulcer, the nurse will: • Check the blood pressure in your arms and compare this with the blood pressure in your ankles. This is called the Doppler test. • The nurse will repeat this test at intervals to check that your circulation has not deteriorated. • This test does not hurtbut can be briefly uncomfortable. You will be askedto lie down for about 20 minutes while the nurse takes the blood pressure readings. • As part of a general health screen, your doctor or practice nurse may arrange some routine blood tests and will ask you questions about your medical history, general health, diet and mobility. It is important that the doctor rules out conditions such as diabetes and rheumatoid arthritis. How long will it take to heal the ulcer? It has usually taken many years of your veins not working properly to cause the ulcer and therefore it is not surprising that ulcers can take some time to heal. Although most venous ulcers will heal in 3-4 months, a small proportion may take considerably longer. Do not despair, even in these resistant cases, treatment is usually successful eventually. In a minority of cases, ulcers may fail to heal. 4 9

5. What is the treatment for a Venous Leg Ulcer? • The treatment of a leg ulcer happens in 2 ways:- • Treatment of the ulcer itself • Controlling the high pressure within the veins • The ulcer is dressed in a similar way to any wound and a suitable dressing will be selected by the nurse once she has assessed your ulcer. Typically you will have your dressings changed once to twice a week. • An ulcer is unlikely to heal with just a dressing though, as the most important thing is to counteract the raised pressure within your veins. This gives the ulcer the best chance of healing. The high pressure is reversed by the use of a compression bandage or compression hosiery which your nurse will apply. This compression will keep the pressure in your veins low at the ankle when you are standing up. The bandages will be more bulky than an ordinary sock so you may need to consider this when choosing which pair of shoes to wear whilst your ulcer is healing. You may even need to buy a bigger pair of shoes during your treatment. If you have some swelling in your ankle or foot, you may find that the bandage helps to reduce this. • Other Treatments and Advice • If your ulcer is due to varicose veins, then surgery may be an option, but usually once the ulcer has healed. If your ulcer fails to respond to treatment, other options may be discussed with your doctor. • Antibiotics are sometimes advised for short periods if the skin and tissues around the ulcer become infected. • If you smoke, try to stop. Smoking is known to slow down wound healing. • Venous ulcers can in some cases be very painful, take painkillers regularly if needed and speak to your doctor or nurse if your pain is not controlled. • Skin care – the skin around the ulcer and the rest of your leg under the compression can be inflamed and scaly. Your nurse will advise you on washing and emollients/cream that may help to moisturise the skin and keep the surrounding skin as healthy as possible. • Dietary advice – try to eat a good balanced diet to ensure you have adequate and balanced nutrition. If you are overweight, losing weight may help. Obesity is a ‘risk factor’ for developing leg ulcers. 8 5

6. NOTE OF CAUTION: • Compression, either as a bandage or hosiery, correctly applied should be comfortable, you will just need to get used to wearing it and may be more conscious of it initially. Give it time. • If the compression is too tight and causing your toes to change colour or temperature, or you are experiencing increasing pain in your foot, contact your nurse or doctor immediately. • If this is not possible, you may remove a layer of bandage or hosiery and then seek advice. Elevation and Activity The higher the leg, the lower the pressure in the leg veins! So, put your legs up whenever you can. When you are resting try to keep your ankles elevated higher than your hips. This will let gravity help to pull blood and fluid in the right direction – towards the heart. Try to set 3 or 4 periods per day of about 30 minutes when you lie down with your leg raised. However, walking is also good for you, so don’t spend all day in bed. Keep as active as you can, do normal activities, take regular walks and try and avoid standing or sitting still for long periods. 6 7