Managing heel ulcers in the community.

As the size of the older population increases, the incidence of falls and injuries, in addition to chronic wounds, is likely to increase concurrently. This article highlights the risk of both pressure ulceration and diabetic foot ulceration and gives an overview of appropriate treatment and management.

Achieving consensus in pressure ulcer reporting.

Pressure ulcers are considered to be a key quality indicator and healthcare providers in England are required to report local pressure ulcer rates. However, there is a lack of standardisation in reporting due to lack of national guidance. The Tissue Viability Society has sought to develop consensus amongst all concerned parties on the most useful and robust methods of data collection. This document has been developed following a consensus meeting and consultation with the majority of Tissue Viability Nurses across England and provides guidance on reporting pressure ulcer rates. It is intended for use all organisations that are involved in the reporting of pressure ulcers. It represents the consensus view of a large number of Tissue Viability Nurses from across England and we recommend its adoption.

Incontinence-associated dermatitis: protecting the older person.

As the older population in the UK continues to grow, so too will the number of people presenting with dermatological problems. Older people's skin is subject to dehydration internally and environmental factors externally. If, in addition, the individual suffers continence problems, he or she is at risk of painful incontinence-associated dermatitis, or even formation of a moisture lesion. The use of an effective barrier cream that gives protection while not interfering with continence pad efficacy can be an invaluable means of comfort to the older person.

Skin changes at life's end: SCALE ulcer or pressure ulcer?

Pressure ulceration causes much distress to patients and family, and can be taken as an indication of poor nursing care. It is vital that both parties understand when pressure damage can be prevented, and those circumstances when skin failure at the end of life cannot be avoided. Appropriate risk assessment, provision of all appropriate care, and use of pressure relieving equipment to minimize the risk of any loss of skin integrity are required. The recognition of Skin Changes at Life's End (SCALE) ulcers may herald the imminent demise of a loved one. Families require support and good communication from nursing staff at this difficult time.

Topical dressings to manage pain in venous leg ulceration.

The pain experienced by patients with venous leg ulceration can be severe, disabling and have an impact on their quality of life. Pain assessment should be an integral part of leg ulcer assessment, since unless pain is successfully managed, the patient may not be able to comply with compression bandaging or exercise and elevation, all of which are crucial components in the successful management of venous leg ulceration. Neuropathic pain can be difficult to identify for both patient and healthcare professional, if it is unrecognized and untreated the patient's ulceration may persist due to an inability to tolerate dressings or bandaging.

Sorbion Sana: a non-adherent, highly absorbent, hypoallergenic dressing.

The management of highly exuding wounds represents a significant clinical challenge. Protection of the surrounding skin from the effects of exudate, while not stimulating a skin sensitivity, can be difficult in venous leg ulcer patients with their higher than usual predisposition for skin allergy/sensitivity. Venous leg ulcer patients can require frequent dressing changes, which are costly in terms of time taken to wash the limb, dress and apply compression bandages, in addition to the actual cost of dressings and compression bandages. This product focus article considers Sorbion Sana, a dressing that provides a means of absorbing and retaining exudate, so reducing the frequency of dressing changes and the likelihood of skin allergy/sensitivity.

Problems encountered managing pressure ulceration of the sacrum.

Pressure ulcers cause a great deal of distress, loss of dignity for the patient and can be problematic in terms of management. Pressure ulceration in the sacral area may lead to added complications if the patient has problems with urinary and faecal incontinence. Maintenance of the patient's skin integrity is vital to avoid added discomfort and distress due to moisture lesions. Prevention of wound and dressing contamination with urine and faeces is difficult and can lead to increases in clinical risk (infection) and cost if not managed successfully.

Classifying and managing pretibial lacerations in older people.

As the population of older people increases it is likely there will be an associated increase in the numbers of patients presenting with pretibial lacerations to GP surgeries, accident and emergency departments and referred to community nurses. This will be due, in part, to the increasing frailty of the skin of the older person, as well as comorbidities, the number of which are also likely to increase with ageing. It is important that the older person with a pretibial laceration is treated promptly and appropriately to prevent complications and optimize healthcare resources.

Compression bandaging: avoiding pressure damage.

Venous leg ulcers account for a large percentage of the financial and healthcare burden of chronic wounds, they are costly to treat both financially and in nursing time. The prerequisites for any healthcare professional to be able to provide safe, effective compression therapy bandaging for any patient must include knowledge, ability and proven competence. Without such competence the patient is vulnerable to harm and the nurse is open to criticism, disciplinary action by the Nursing and Midwifery Council or even litigation. Pressure damage to patients' skin under compression therapy can occur due to a number of factors and it is the responsibility of a registered nurse to ensure compression bandaging is safely and expertly applied.

Management options for patients with pretibial lacerations.

Pretibial lacerations are a common injury, particularly in older adults. Patients may present to the emergency department for treatment, be treated in GP surgeries by community nurses or they may self-treat. This article reviews the treatment options available to enable healthcare professionals to make informed decisions regarding the management of patients with such injuries.

Avoiding allergic contact dermatitis in patients with venous leg ulcers.

The management of venous leg ulcers is frequently problematic, usually as a result of the patient's existing co-morbidities, but often because of problems in skin management, such as hyperkeratosis or skin sensitization and resulting contact dermatitis. Good leg ulcer management practice includes skin care, protection from excessive exudate and from potential sensitisers. This article explores how the practitioner can recognize allergic contact dermatitis in a patient with a venous leg ulcer and avoid the use of avoid potential skin sensitizers during management.

Comparison of four different dressings on donor site wounds.

Following nursing observation of the difficulties of healing of donor site wounds, including trauma and pain on removal of dressings, a blind randomized study was undertaken to determine which of four dressings provided the greatest comfort, had the fastest healing time and could be removed without trauma. Forty patients had one of four dressings applied in theatre: paraffin gauze, alginate alone, alginate with film cover or film alone. An observer was present who was unaware of the dressing used and recorded patient observations and nursing records for information. The study revealed that the dressing that caused patients most discomfort and trauma on removal was paraffin gauze. Alginate with film dressing was found to be most successful in treating these patients.

Examining the literature on using tap water in wound cleansing.

Practitioners working in the community setting and whose caseload predominantly consists of treating chronic wounds often use tap water as a wound cleanser with the rationale that chronic wounds are already colonised with bacteria. However, there is some controversy, as discussed within this review, of the suitability of tap water as a cleansing agent for acute wounds.

Skin grafts 2: management of donor site wounds in the community.

Skin grafting is a surgical procedure used to quickly restore skin integrity in large wounds or those wounds which cannot be directly closed by suturing. The procedure of skin grafting necessitates the creation of a second wound; the donor site. Although often viewed as secondary importance by surgeons once skin has been harvested from the area, it is the donor site which frequently causes complications such as pain/discomfort and slow healing (Wilkinson, 1997). Because skin graft sites and donor sites are viewed as part of a specialist practice, their wound management is regarded as being 'something different'. However, the donor site is a partial-dermal thickness wound and should be seen as such, rather than a 'special' wound. This may help to lessen the anxiety felt by both patient and nurse in dealing with donor site wounds.

Skin grafts 1: theory, procedure and management of graft sites in the community.

The skin may not have the same dramatic appeal as many of the other organs, such as the heart; however, it plays a vital part in identifying each of us as a unique individual. When this protective outer barrier is damaged the consequences may be far reaching in both psychological and physical terms. Not all wounds require skin grafting - small, superficial wounds will heal by secondary intention and dressings. However, use of skin grafting to restore skin integrity for large surface wounds such as burns, reduces the risk of infection and enables the individual to resume normal daily activities more rapidly. This article explores the process of skin grafting and subsequent care of skin graft wound sites.

Transfoam Visco: evaluation of a viscoelastic foam mattress.

It is both a massive financial commitment and a huge financial decision to standardize mattresses in a large trust. It should only be undertaken after evaluation of the evidence of efficacy supplied by relevant companies, together with independent research and reports by healthcare professionals. In addition, evaluation of the equipment should be made by back care advisers, from a user-safety viewpoint and physiotherapists, occupational therapists concerning rehabilitation. Ward-based nurses and patients need to assess equipment for comfort, ease of repositioning individual, and ability to relieve pressure. This article outlines the process by which a static mattress was evaluated for ease of movement, pressure relief and comfort by patients and healthcare professionals. The possible longevity of the mattress was considered as secondary relevance; however, cost-effectiveness and quality of product are essential in today's acute healthcare setting.