Treating a venous leg ulcer

With appropriate treatment, most venous leg ulcers heal within three to four months.

Treatment should always be carried out by a healthcare professional trained in compression therapy for leg ulcers. Usually, this will be a practice or district nurse.

Cleaning and dressing the ulcer

The first step is to remove any debris or dead tissue from the ulcer and apply an appropriate dressing. This provides the best conditions for the ulcer to heal.

A simple, non-sticky dressing will be used to dress your ulcer. This usually needs to be changed once a week. Many people find they can manage cleaning and dressing their own ulcer under the supervision of a nurse.

Compression

To improve vein circulation in your legs and treat swelling, your nurse will apply a firm compression bandage over the affected leg. These bandages are designed to squeeze your legs and encourage blood to flow upwards, towards your heart.

There are many different types of bandageor elastic stockings used to treat venous leg ulcers, whichmay be madein two, three or four different layers. The application of a compression bandage is a skilled procedure and they should only be applied by trained healthcare staff.

The bandage is changed once a week, when the dressing is changed.

When compression bandages are first applied to an unhealthy ulcer, it's usually painful.Ideally, you should have paracetamol or an alternative painkiller prescribed by your GP.The pain will lessen once the ulcer starts to heal, but this can take up to 10-12 days.

It's important to wear your compression bandage exactly as instructed. If you have any problems, it's usually best to contact your nurse, instead of trying to remove it yourself. If the compression bandage feels a little too tight and is uncomfortable in bed at night, getting up for a short walk will usually help.

However,you'll need to cut the bandage off if:

• you get severe pain at the front of your ankle
• you get severe pain on the top of your foot
• your toes become blue and swollen

Once you remove the bandage,make sure you keep your leg highly elevated and contact your doctor or nurse as soon as possible.

In some clinics, specialist teams are using new alternatives to compression bandages, such as special stockings or other compressive devices. These may not be available in every clinic butcould change the way ulcers are treated in future. Your specialist will be able to advise you whether a different approach may help you.

Treating associated symptoms

Swelling in the legs and ankles

Venous leg ulcers are often accompanied by swelling of your feet and ankles ( Angioedema ), which is caused by fluid. This can be controlled by compression bandages.

Keeping your leg elevated whenever possible, ideally with your toes at the same level as your eyes, will also help ease swelling. You should put a suitcase, sofa cushion or foam wedge under the bottom of your mattress, to help keep your legs raised while you sleep.

You should also keep as active as possible and aim to continue with your normal activities. Regular exercise, such as a daily walk, will help reduce leg swelling. However, you should avoid sitting or standing still with your feet down. You should elevate your feet at least every hour.

Itchy skin

Some people with venous leg ulcers develop rashes with scaly and itchy skin.

This isoften due to varicose eczema , which can be treated with a moisturiser (emollient) and occasionally a mild corticosteroid cream or ointment. Inrare cases,you may need to be referred to a dermatologist (skin specialist) for treatment.

Itchy skin can also sometimes be caused by an allergic reaction to the dressings or creams applied by your nurse. If this happens, you may need to be tested for allergies.

It's important to avoid scratching your legs if they feel itchy, because this damages the skin and may lead to further ulcers.

Looking after yourself duringtreatment

To help your ulcer heal more quickly, follow the advice below:

• Try to keep active by walking regularly. Sitting and standing still without elevating your legs can make venous leg ulcers and swelling worse.
• Whenever you're sitting or lying down, keep your affected leg elevated withyourtoes level with your eyes.
• Regularly exercise your legs by moving your feet up and down, and rotating them at the ankles. This can help encourage better circulation.
• If you're overweight, try to reduce your weight witha healthy diet and regular exercise.
• Stop smoking and moderate your alcohol consumption . This can help the ulcer heal faster.
• Be careful not to injure your affected leg, and wear comfortable, well-fitting footwear.

You may also find it helpful to attend a local healthy leg club, such as those provided by the Lindsay Leg Club Foundation , for support and advice.

Treating an infected ulcer

An ulcer sometimes produces a large amount of discharge and becomes more painful. There may also be redness around the ulcer. These symptomsand feeling unwell are signs of infection.

If your ulcer becomes infected, it should be cleaned and dressed as usual.

You should also elevate your leg most of the time and you'll be prescribed a seven-day course of antibiotics .

The aim of antibiotic treatment is toclear the infection. However, antibiotics don't heal ulcers and should only be used in short courses to treatinfected ulcers.

Follow-up

You should visit your nurse once a week to have your dressings and compression bandages changed. They'll also monitor the ulcer to see how well it's healing. Once your ulcer is healing well, your nurse will see you less often.

After the ulcer has healed

Once you've had a venous leg ulcer, another ulcer could develop within months or years.

The most effective method of preventing this is to wear compression stockings at all times when you're out of bed. Your nurse will help you find a stocking that fits correctly and that you can manage yourself.

Various accessories are available to help you put them on and take them off.

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