Recurrent venous leg ulcers: management in general practice
Venous leg ulcers commonly recur. Annemarie Brown highlights some self-care strategies that patients can use to reduce their risk
Chronic venous leg ulcers are commonly seen in general practice and although healing rates for leg ulcers have improved, recurrence rates are high with around 60–70% reported to recur after healing. The primary prevention strategy is the life-long wearing of compression hosiery; however, compliance is low for several reasons including lack of understanding of the need to wear compression hosiery and difficulties applying and removing it. Self-care strategies such as physical exercise and mobility, leg elevation and appropriate skin care, can help to prevent recurrence of venous leg ulcers. Practice nurses are ideally placed to provide this advice, which can help improve patient's quality of life while reducing the financial burden of treating open ulceration for the NHS.
Chronic venous leg ulcers (VLU) are commonly seen in general practice. Guest et al (2015) estimate that approximately 1.5% of the adult population in the UK is affected by active leg ulceration, meaning that up to 730 000 patients have open leg ulceration at any given time (Guest et al, 2015). With the implementation of the gold standard treatment – compression therapy – healing rates of 76.3% have been recorded at 24 weeks (O'Meara et al, 2012; Nelson and Adderley, 2016).
Despite improved healing rates, however, recurrence rates are depressingly high. Around 60–70% of all VLUs are reported to recur after healing, with the highest recurrence rate within 3 months and the majority recurring within 12 months (McDaniel et al, 2002; Abbade and Lastória, 2005). A quarter of all patients will experience in excess of 10 episodes of active ulceration in their lifetime (Weller et al, 2013).
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