Comment - We need consensus on mixed aetiology ulcers

Irene Anderson, BSc, DPSN, RN, chairperson, Leg Ulcer Forum; Eileen Shepherd, DipN, Editor, Chronic Wound Management

The last issue of Chronic Wound Management featured an article on the management of mixed-aetiology leg ulcers (Anderson and King, 2006) that has ignited an important debate.

The last issue of Chronic Wound Management featured an article on the management of mixed-aetiology leg ulcers (Anderson and King, 2006) that has ignited an important debate.

The article identified a lack of clarity about how mixed-aetiology ulcers should be managed and variations in practice across the country.

Guidelines for the management of venous leg ulceration have been available since the late 1990s. These guidelines have provided a consensus on best practice and have enabled nurses to provide evidence-based care. The result has been improved rates of healing.

We also know that up to 20% of people with venous ulceration have some arterial disease as well and this arterial component is often progressive. The status of these wounds is therefore dynamic and management needs to respond to changes in the underlying pathophysiology.

The problem for practitioners is that the guidelines for venous legulcers do not include mixed-aetiology ulcers and the advice available for the management of these mixed ulcers can be confusing.

It is generally accepted that, following careful assessment, reduced compression can be used when a venous ulcer has an arterial component.

The pressures suggested in the literature are in the 15-30mmHg range. Although specifically designed reduced compression bandages are now available, it is unclear what we actually mean by reduced compression and there is a lack of consensus about how bandages should be applied to achieve this.

We know that many nurses have problems maintaining their competence in the application of full compression therapy if they do not use the skills for this regularly. Nurses who have to apply reduced compression need to be able to adapt their bandaging skills and patient care may suffer if their nurses have not received additional education to do this task. This begs the question - should patients with mixed-aetiology ulcers be managed in specialist clinics where they can be assessed and monitored by nurses with advanced skills?

The Leg Ulcer Forum is planning to conduct a survey early next year to identify how mixed-aetiology ulcers are managed in practice and this will be the first step to producing guidelines to support nurses in their practice.

Reference:
Anderson, I., King, B. (2006) Mixed-aetiology ulcers.Nursing Times; 102: 160, 45-50.