Outcomes of a new wrap compression system for patients with lower limb ulceration and oedema.

JOBST® FarrowWrap® is indicated in patients presenting with venous leg ulceration in combination with mild-to-moderate oedema. These symptoms result in significant physical and psychological problems and management can be costly in terms of duration of input and resources. This article will present four case studies demonstrating the benefits and outcomes for patients with lower limb issues and will consider how the product helps improve shape, reduce oedema, heal ulceration, improve quality of life in relation to the lower limb and encourage self-care.

Assessing and managing patients with leg ulceration and oedema.

Leg ulcers are some of the most common wounds treated by the NHS. Ulceration is usually classified as being of venous or arterial origin. Arterial ulcers develop because of reduced arterial flow to the leg caused by peripheral arterial disease. Venous leg ulcers, the most common form, develop because of vein incompetence, with valve failure leading to pressure in the veins. Nurses working with patients with oedema find that chronic oedema can cause the limb affected to swell, causing skin to stretch and break and lead to ulceration. This is known as superficial ulceration. This article discusses the causes, assessment and management of these different types of leg ulcer.

Compression therapy for chronic oedema and venous leg ulcers: CoFlex TLC Calamine.

The prevalence of venous leg ulcers and chronic oedema is increasing because of the rise in the older population who have comorbidities. Managing and living with these conditions is extremely costly in resource and human terms and there is often a cyclical process of ulceration, healing and recurrence, resulting in significant physical and psychosocial morbidity. Identifying those at risk and advising on lifestyle changes to prevent progression of these conditions will help in avoiding high wound management and compression costs, nursing input and associated patient morbidity. Compression bandaging is the linchpin in managing these conditions and it must be started as early as possible. However, many patients find it difficult to tolerate bandaging because of issues such as pain, the inability to wear shoes and itch. Therefore, if compliance is to be achieved, it is important to select a compression bandaging system that addresses the issues that patients have difficulty with. AndoFlex TLC Calamine is a compression bandaging system that deals with many of these problems, and is easy to apply and remove. Testimonials by practitioners treating patients with chronic oedema, ulceration and/or skin problems will demonstrate the benefits and effectiveness of AndoFlex TLC Calamine.

Impact of multimorbidity on chronic oedema management in the older person.

The population is ageing but many older people are living with chronic multimorbidity, which has a significant impact of all aspects of quality of life. Many of the common chronic conditions suffered by older people either precipitate or compound chronic oedema, which means a wide range of skills and in-depth knowledge is required to deliver holistic care that does not interfere with other treatment modalities. This patient group often presents with highly complex coexisting issues that require highly specialist assessment and management in collaboration with other professionals.

Assessment and management of older people with venous leg ulcers.

A venous leg ulcer (VLU) is defined as the loss of skin below the knee on the leg or foot in the presence of venous disease, which takes more than two weeks to heal. The prevalence of VLUs is increasing, especially in older people, which will increase the demand for nursing care. Development of a lower leg ulcer should trigger immediate assessment of risk factors for chronic venous disease followed by action to identify the cause and initiate treatment, which should prevent progression to more complex and chronic problems. Justification for choice of appropriate wound management and application of compression therapy should be based on the assessment and diagnosis. Management of patients with VLUs can be cyclical and lifelong, which highlights the importance of helping patients to understand the rationale for management strategies so that cooperation in self-care is achieved.

Mobiderm Autofit: an adjustable sleeve that enables patients to self-manage lymphoedema.

Lymphoedema can result in debilitating physical and psychosocial morbidity and when combined with other chronic comorbidity, often requires holistic, specialist management that encompasses all the complex and compounding problems. Self-care is an integral component of any treatment strategy, however, the patient must be fully prepared and ongoing support should be provided. Self-care consists of managing the symptoms of lymphoedema but should include other fundamental aspects of healthy living, for example, maintaining a healthy weight and activity levels. To improve self-care, compression manufacturers have been instrumental in designing new ways of applying compression. Mobiderm Autofit armsleeves have been designed to improve the donning and wearing of compression sleeves in all patients. This product is especially useful for night-time wear and in the presence of fragile skin, or for those who only require reduced compression. The benefits of this garment are demonstrated in three case studies.

Management of chronic oedema in patients with multiple morbidity.

Marie Todd, Lymphoedema Clinical Nurse Specialist, Specialist Lymphoedema Service, Glasgow, discusses the difficulties of caring for people with compounding conditions.

Identification, assessment and management of breast oedema after treatment for cancer.

Advances in breast cancer management, including breast-conserving surgery, have resulted in an increase in the incidence of breast oedema. However, this is addressed by professionals less often than arm lymphoedema. Breast oedema results in significant physical and psychological morbidity, makes finding a comfortably fitting bra very difficult, and can act as a reminder of the initial breast cancer diagnosis. Psychological difficulties can be compounded by clinicians' failure to acknowledge the impact. Assessing and managing breast oedema requires a sensitive, skilled approach to ensure all the relevant issues are identified and addressed in a comprehensive care plan; taking time to listen to patients and acknowledging the impact can be very therapeutic. The principles of managing breast oedema are based on lymphoedema practice, particularly manual lymphatic drainage and kinesio taping. This article gives an overview of the identification, assessment and management of breast oedema following treatment of cancer.

Audit of skin changes present in referrals to a specialist lymphoedema service.

An audit of 100 new patients attending a specialist lymphoedema clinic revealed 52% presented with chronic oedema. More than half (58%) of the chronic oedema group presented with skin changes whereas 14% of those with lipoedema, 4% with lymphoedema of the arm, and 8% with lymphoedema of the leg developed skin changes. None of the primary lymphoedema group developed skin changes. Chronic venous disease (CVD) was significantly more prevalent in the chronic oedema group. More patients with bilateral chronic oedema suffered from cellulitis (41%) compared to unilateral (27%). Skin changes, CVD and red leg syndrome (RLS) also occur more often in bilateral leg swelling. Incidence of cellulitis is highest in the chronic oedema group (36.5%), closely followed by the primary lymphoedema group (33.3%). 85% of the patients who were weighed (n=93) were overweight, 39% obese, and 29% morbidly obese. The findings from this audit highlight the importance of skin care training for community nurses managing chronic oedema patients.

Managing ulceration and lymphorrhea in chronic oedema.

This clinical review article on the combined use of JOBST FarrowWrap and Cutimed® Sorbion® Sachet XL uses a case study methodology to demonstrate how effective this approach is in managing superficial ulceration and/or lymphorrhea in the presence of chronic oedema and lymphoedema. The blend of these symptoms causes significant physical and psychosocial issues for patients and is highly labour and resource intensive. However, there is often inadequate treatment choice leading to protracted input by nurses and delayed or failed healing. Only by combining an effective exudate/lymphorrhea dressing choice with compression therapy, will there be a positive outcome and this will result in reducing nursing input, cost to the NHS, and enhance patient self-care.

A core outcome set for studies evaluating the effectiveness of prepregnancy care for women with pregestational diabetes.

AIMS/HYPOTHESIS: The aim of this study was to develop a core outcome set (COS) for trials and other studies evaluating the effectiveness of prepregnancy care for women with pregestational (pre-existing) diabetes mellitus. METHODS: A systematic literature review was completed to identify all outcomes reported in prior studies in this area. Key stakeholders then prioritised these outcomes using a Delphi study. The list of outcomes included in the final COS were finalised at a face-to-face consensus meeting. RESULTS: In total, 17 outcomes were selected and agreed on for inclusion in the final COS. These outcomes were grouped under three domains: measures of pregnancy preparation (n = 9), neonatal outcomes (n = 6) and maternal outcomes (n = 2). CONCLUSIONS/INTERPRETATION: This study identified a COS essential for studies evaluating prepregnancy care for women with pregestational diabetes. It is advocated that all trials and other non-randomised studies and audits in this area use this COS with the aim of improving transparency and the ability to compare and combine future studies with greater ease.

Diagnosis and management of lipoedema in the community.

Lipoedema is a chronic progressive adipose disorder that affects mainly women and presents as symmetrical enlargement of the buttocks and legs. It is commonly misdiagnosed as obesity or lymphoedema, but careful assessment will reveal a disproportionate enlargement below the waist which is resistant to dieting, sparing of the feet, legs are tender or painful to touch and bruise easily, there is occasional orthostatic oedema, and there is often significant psychological morbidity. Lipoedema is a oestrogen-regulated condition with onset around puberty in 78% of women, and there is often a strong family history. The condition is exacerbated by weight gain and there is increasing anecdotal evidence that women who are obese are seeking a diagnosis of lipoedema, either to procure NHS funded manual lymphatic drainage, or to medicalise their obesity and avoid acknowledging that the responsibility for their weight gain is lifestyle orientated. Management of lipoedema consists of accurate diagnosis, psychological care, management of orthostatic oedema, and prevention of progression through skin care and weight management.

Childhood lymphoedema and 'Lymphaletics': overcoming barriers.

Primary lymphoedema is a complex condition that causes tissue swelling, usually in one or more of the limbs, but lymphatic drainage of the head, trunk or deeper organs may also be affected. It can manifest in swelling at any time from birth meaning there are a number of children affected by this condition. While it is rare in childhood there are too few professionals experienced in diagnosis and treatment, which results in delays in identification and referral to appropriate services for diagnosis and treatment. The Children's Lymphoedema Special Interest Group (CLSIG) was formed in 2010 by a group of lymphoedema specialists in a bid to raise awareness, improve service provision, and enhance practitioner knowledge. One of the aims of the group was to deliver a 'fun day' (Lymphaletics) for children with lymphoedema and their families to encourage physical activity and social interaction with children who have similar problems, and to provide a source of parent-to-parent support. This article discusses the issues for children and their families, and the aims and format of the event.

Managing chronic oedema and venous disease with made-to-order garments.

Selecting the most appropriate compression garments is vital in the long-term management of venous disease and chronic oedema. The range of styles has improved greatly over the years and many garments are available on the UK Drug Tariff. Practitioners now have a wide range of options to choose from including the type of fabric, colour, compression class, and style of garment. These options increase the pratitioner's ability to select the most suitable garments and combine clinical and aesthetic needs, with the ultimate aim of improving compliance. The focus of this article is to highlight the aims and qualities of the various types of compression garments available, discuss the rationale for prescribing choice, and describe the benefits of Haddenham's Veni made-to-order compression leg garments in the management of chronic oedema and venous disease. Three case studies will demonstrate the effectiveness of the Veni made-to-order range of compression garments.