Update - Hard-to-heal ulcers must be identified early on

VOL: 102, ISSUE: 44, PAGE NO: 40

Nurses attending the Leg Ulcer Forum conference were encouraged to identify hard-to-heal leg ulcers at an early stage and use new treatments to accelerate their healing.

Nurses attending the Leg Ulcer Forum conference were encouraged to identify hard-to-heal leg ulcers at an early stage and use new treatments to accelerate their healing.

Kath Vowden, nurse consultant at Bradford Royal Infirmary, urged delegates to consider risk factors for delayed healing. These include large wounds (>10cm²) and those of a long duration (>6 months) at initial assessment and ulcers that fail to reduce in size by 40% after three weeks of compression. Ms Vowden said following identification, nurses should consider adjunctive therapy for these wounds (see box below).

Considerations for wounds that fail to respond to standard therapy

• Review patient factors

Reassess diagnosis

Factors delaying healing

Concordance

• Assess wound for

Infection

Ischaemia

Inflammation

• Review compression

System, application

• Adjunctive therapy

Reduce bacterial load - use antimicrobials

Manipulate the wound bed - for example with growth factors or vacuum-assisted closure

Pharmaceutical management - for example pentoxifylline and aspirin

Surgery - for example, varicose veins or skin grafting

Bio-engineered skin