Timescaled monitoring to manage venous leg ulcers and chronic oedema.

Venous leg ulcers and chronic oedema including lymphoedema are lifelong conditions that cause great distress to sufferers due to psychophysical symptoms. Time and resources spent on managing chronic wounds place an economic burden on healthcare providers, particularly with an anticipated increase in an ageing population and diminishing numbers of those providing long-term care. Resources are further challenged if wounds remain unhealed. The human costs are even greater, with patients often facing a lifetime of discomfort due to low awareness of venous disease, despite epidemiological studies. Possible causes of persistent venous disease may be misdiagnosis, mismanagement, or simply, no management if help is not sought. Therefore, it is important that chronic leg ulcers are managed with clinically effective regimes, reassessment, monitoring and appropriate referrals for adjunct management, alongside patient education. This article provides simple timescaled measurements to ensure timely interventions and appropriate care at each stage.

Three wound types: common challenges with exudate, gaps and anatomical positioning.

Complex wounds require combinations of technologies and regimes to match laboratory tests and address challenges of physiological processes, body contours, movement and ease of use during life-long self-management. Wound management for vascular and lymphatic disorders incorporate wound dressings, skin care and compression to address local wound needs and underlying pathologies, while allowing functionality for movement. In a similar manner, acute inflammatory conditions that become chronic require skin care and local conformable and absorbent wound management, but with simple, atraumatic retention methods without compression. Three types of conditions will be discussed in this article-venous leg ulcers with chronic oedema (VLU), hidradenitis suppurativa (HS) and pilonidal sinuses (PS). It focuses on overcoming challenges associated with excess exudate, compromised skin, dressing awkward areas and contours, while also demonstrating wound care similarities when administered by patients themselves.

Uterine prolapse: impact of the condition and practical advice.

Pelvic-organ prolapse is where organs such as the uterus move out of place; in some cases, they can protrude out of the body. It occurs when muscles extending from the pubic bone to the coccyx or the levator ani muscles become weak or are injured. Although it is not life-threatening, the condition can be life limiting, adversely affecting physiological processes, function and quality of life, with patients reporting years of pain, discomfort, humiliation and embarrassment. Uterine prolapse is often under-reported as women may feel resigned to a condition that is viewed as part of getting old or the menopause, or a consequence of childbirth; they may also feel embarrassed. Gynaecology has the fastest growing waiting lists of any NHS specialty, and women may wait a long time for treatment. This article focuses on uterine prolapse, management of symptoms from conservative self-help to surgical options, and includes a case study of a successful laparoscopic hysteropexy with bifurcated polypropylene mesh apical support procedure carried out by a skilled surgeon.

24-hour interval compression: a plan to balance effectiveness and tolerability for chronic oedema.

As one of the mainstays for the management of chronic oedema, compression is unquestionably an efficacious and important element in treatment pathways during the intensive acute, transition and maintenance phases. Despite the variety of compression technologies on the market, devices to aid application and innovative methods employed by caregivers to encourage adherence to treatment, concordance remain a challenge. Balancing clinical effectiveness and patient comfort, the 24-hour interval plan considers wearer lifestyle and treatment options to tailor types of compression and times during the day and night when compression is worn. This article reviews previously published theories and evidence on which the 24-hour compression plan has been based (Bock et al, 2022).

The 24-hour interval compression plan: part 2-lifestyle and therapeutic regimens to manage chronic oedema case series.

OBJECTIVE: The aim of this case series was to retrospectively assess the impact on volume control and patients' quality of life (QOL) when a night-time garment was added to their previous compression regimen for a full 24-hour interval compression plan. METHOD: Patients who had a history of chronic oedema presented to one of two oedema management centres in the US for treatment for oedema exacerbation and/or suboptimal performance of their current garments. Objective data examined were circumferential limb volume (cm3) measurements and QOL measured with the Lymphoedema QOL Tool (LYMQOL-Leg and LYMQOL-Arm). Subjective comments on functional abilities and perception of improvement with a compression plan that comprised a 24-hour interval were documented. RESULTS: All three patients presented in this case series had a reduction in limb volume and improvement in QOL when their daytime regimen of garments was updated and new night-time garments were added. Their subjective comments indicated improvement in activities of daily living and ease of controlling daytime oedema with a 24-hour interval compression plan. CONCLUSION: This case series illustrates the need for clinicians to create a partnership with the patient to promote concordance and adherence as part of their individual 24-hour interval compression plan. This partnership allows the plan to be uniquely changed and adjusted to allow each patient to feel in control of refreshing their mood, their skin and their garments.

A 24-hour interval compression plan for managing chronic oedema: part 1-the science and theory behind the concept.

Compression, skin care, manual lymph drainage and exercise form the mainstays of treatment of chronic limb oedema. The compression aspect of the regimen is often prescribed and used without conscious concern for the patient's ability for self-adjustment and skin hygiene. This article will focus on the action of compression therapy using a new concept of encouraging patients to apply and reapply an adjustable compression garment or multiple garment types during a 24-hour interval. The benefits of this focus on interval compression therapy on all aspects of care will be explained and case studies presented.

Compression hosiery for venous disorders and oedema: a question of balance.

Compression therapy for venous and lymphatic conditions may be delivered via a range of treatment modalities using many different technologies, depending on the patient's condition and needs. Clinical decision-making relies on accurate assessment of the patient, their presenting and underlying clinical condition, skill and training of the applier and the available resources. However, changes in the patient's condition or lifestyle may necessitate re-evaluation of the treatment pathway. Generally, compression bandages and Velcro wraps are used in the intensive acute phase of treatment, with self-management using compression hosiery or wraps being used for long-term maintenance to prevent recurrence. Although guidelines recommend the highest class of compression hosiery for maximum effectiveness, clinical evidence shows practical challenges associated with application and tolerance of higher pressures and stiffness. An audit of a new type of compression garment was conducted, and it showed that incorporating stiffness into circular knitted hosiery helped overcome some of these challenges with improvements in limb size, skin softening and wound size. Additionally, self-management was facilitated by the ease of donning and doffing.

Interface pressures with compression systems: relevance to clinical practice.

Interface pressures with compression depend on many factors relating to the science of measurement and intrinsic, patient-related factors, including limb size and tissue texture. While it is important for manufacturers of compression devices to measure pressures, it may not always be relevant to clinical practice where application methods and oedematous limbs may affect final pressures. Accurate performance of any compression system relies on the use of the right technology for the right condition and patient lifestyle. Correct application following training and in accordance with instructions for use may be adapted according to individual patient comfort and needs, including mobility, tissue texture and the stage of management. In order to provide treatment regimens that are safe, effective and well tolerated by patients, as well as being easy to apply and demonstrate sound economic practice, science needs to meet clinical practice. Patient reporting is an important for successful treatment, matching clinical effectiveness with patient acceptance during reassessment and monitoring.

Intermittent pressures in compression bandaging for oedema management.

Chronic oedema is an increasing problem requiring higher levels of knowledge and research. With improvements in education and specialist products, management of patients with uncomplicated oedema can be undertaken by non specialist practitioners. Despite recent advances there remains a paucity of research that provides information to link science and theory to clinical practice. This article seeks to review studies that challenge older beliefs and focus on new theories that underpin management with compression to improve clinical effectiveness and patient comfort.

Short-stretch compression bandages and the foot pump.

Short-stretch compression bandages have been shown to be as cost-effective and efficient as other compression systems in healing venous ulcers, independent of associated factors (Scriven et al, 1998; Nelson, 1996). However, as they do not contract around a limb they do not exert pressure during inactivity (resting pressure) (Klose Norton, 2003). But their stability creates a high resistance to stretch when pressure is applied through internal muscle contraction and joint movement (working pressure) (Tuckwood, 1996).