The application of modified compression to prevent leg ulcer recurrence in the Republic of Ireland

Background: Compression therapy is considered best practice for healing and preventing venous leg ulcer (VLU) recurrence, however, some comorbidities require that modified compression be applied. A range of terminologies, application recommendations and compression amount for modified compression are found in the literature and guidelines. This could implicate how these recommendations are transferred into clinical practice.

Aim: To investigate clinical practice regarding the application of modified compression to prevent recurrence of VLU in the Republic of Ireland.

Methods: Descriptive qualitative design was used, with six experts in compression and wound management recruited from Ireland. Semi-structured interviews were used to gather data, and reflexive thematic analysis was completed.

Results: We identified four themes during data analysis; inconsistent understanding and terminology usage; clinical context influences; issues with standard compression application; and focus on healing (non-routine monitoring) with associated subthemes. 

Conclusions: This research indicates that the application of modified compression to prevent the recurrence of leg ulcers is limited within clinical practice, with inconsistent terminology used, application methods, and non-routine monitoring to prevent recurrence. Reported systemic barriers impact the ability of these services to provide best practice to people with leg ulcers.

Declaration of Interest: No conflict of interest to declare.

KEY WORDS

Clinical practice

Compression

Venous leg ulcers

YVONNE PENNISI

Occupational Science and Occupational Therapy University College Cork, Brookfield Health Science Campus, Cork, Ireland

PROFESSOR NICOLE MÜLLER Head of School, Clinical Therapies, University College Cork, Brookfield Health Science Campus, Cork, Ireland

SIOBHAN MURPHY Lecturer, School of Nursing, University College Cork, Brookfield Health Science Campus, Cork, Ireland

DR CLAIRE M BUCKLEY Senior Lecturer, School of Public Health University College Cork, Western Gateway Building, Cork, Ireland Orcid ID: 0000-0002-3174-7022

PICO™ Single Use Negative Pressure Wound Therapy (sNPWT) non-healing wound clinical practice pathway

In the UK, approximately 4.5 million, or one in fifteen people, are affected by diabetes, including both those who have received a diagnosis and those who have not. In the next 2 to 3 years, it is expected that the prevalence of diabetes will exceed 5 million. This article will discuss a patient with a non-healing diabetic foot ulcer and how the implementation of active treatments, such as PICO single-use negative pressure wound therapy (sNPWT), alongside the PICO sNPWT non-healing wound clinical practice pathway, assisted in achieving wound closure for the patient.

KEY WORDS

Diabetic foot ulcer;

Non-healing wounds;

Patient guidance;

PICO™ sNPWT

ANDREW SHARPE

Advanced Podiatrist, Wound Care, Salford Care Organisation

This article and the best practice statement were sponsored by Smith+Nephew. The views presented in this document are the work of the author and do not necessarily reflect the views of Smith+Nephew.

Management of a fistula in the open abdomen

Abstract: A fistula is an abnormal connection between two body parts. Patients may develop an enterocutaneous fistula following bowel surgery when the abdomen is left open. Managing these patients is complex and requires a multifaceted approach. Some of the issues are discussed and a patient case is presented in the following paper. Difficulties around managing the wound in particular are highlighted. Negative pressure wound therapy (NPWT) options are considered as well as other dressing choices.

KEY WORDS

Fistula

Negative pressure wound therapy

Open abdomen

Wound healing

ALEXANDRA J BISHOP

Lead Tissue Viability Nurse, University Hospitals Plymouth

Interface pressure: what does it mean in clinical practice?

ABSTRACT: Pressure ulcers generally occur at body sites where there are sustained soft tissue stress concentrations associated with either bodyweight or medical devicerelated mechanical forces. These sustained mechanical forces caused by pressure and shear result in localised tissue/cell distortion. This leads to deformation-induced damage, inflammation and ischemia resulting in tissue death and, ultimately, a pressure ulcer (Katz and Gefen, 2023).

      In order to reduce the risk of pressure damage occurring, it is common in clinical practice to select a pressure redistributing support surface (mattress or cushion). It is also important to reposition the patient in order to both change the areas that are load bearing and — as much as possible — increase the surface area of the body that is supporting the load, while avoiding positioning on the most at-risk areas, for example the bony prominences.

KEY WORDS

Interface pressure

Pressure mapping

Pressure ulcer

JACQUI FLETCHER

Independent Nurse Consultant

Implementing an evidence-based pathway to improve outcomes for non-healing wounds

ABSTRACT: In order to provide structured and equitable interventions in relation to identification and management of wound infection, an NHS Trust has implemented an evidence-based pathway for non-healing wounds. Following the introduction of the pathway there were reduced nurse visits for wound assessment, a reduction in wound area, a reduction in necrotic tissue and improved healing rates.

KEY WORDS

Case study

Evidence

Infection

Pathway

Silver dressing

UrgoClean Ag

Wound

ANITA KILROY-FINDLEY, Clinical Lead Tissue Viability, Leicestershire Partnership NHS Trust

KAREN OUSEY, PhD, Professor of Skin Integrity, Institute of Skin Integrity and Infection Prevention, University of Huddersfield

Frugal innovation in wound management within a low resource inpatient setting: a case series

Objective: This article highlights challenges of wound care in low resource settings, considering opportunities for frugal innovation and our experiences while creating virtual wound care clinics across two global communities. In addition, we will discuss four real cases presented within the virtual clinics. An adaptation of the widely accepted tissues, infection, moisture, edge, regeneration and repair of tissue, and social factors (TIMERS) wound assessment is also proposed with considerations for low-resource setttings. 

Method: From March to December 2021 the University of Salford engaged in a virtual wound clinic initiative with colleagues in Fort Portal Regional Referral Hospital.

Results: The clinics provided opportunities for professional and academic development of students on postgraduate tissue viability module in Salford, while empowering nurses and midwives in Uganda in taking their place at the centre of multidisciplinary teams in care delivery Furthermore, it created links between the university and clinicians in Uganda to develop the delivery of evidence-based wound management. Throughout this period, challenges associated with low resources were highlighted and, in some cases, innovative approaches to managing wound care were adopted to account for this.

Conclusions: The development and delivery of the virtual wound care clinics between the University of Salford and Fort Portal Regional Referral Hospital provided an opportunity for reflection on practice. This led to development of a Fit4purpose wound dressing, revision of evidence-based guidelines, deeper understanding of the scarcity of essential items and frugal practice, and examination of skin tone bias in the signs and symptoms of wound infection in patients with dark skin tones.

KEY WORDS

Case series

Dressings

Frugal innovation

Low resource

Uganda

Wounds

DR MELANIE STEPHENS

PhD, RGN, Senior Lecturer in Adult Nursing and Lead for Interprofessional Education, School of Health and Society, Mary Seacole Building, University of Salford, UK

MATTHEW WYNN,

MSc, RN Adult, Lecturer in Adult Nursing, School of Health and Society, Mary Seacole Building, University of Salford, UK

SHEBA PRADEEP

MSc, RN Adult, Lecturer in Adult Nursing, School of Health and Society, Mary Seacole Building, University of Salford, UK

LOUISE ACKERS

Chair in Global Social Justice, Director Knowledge, Health and Place Research

RACHEL NAMIRRO

Registered Midwife, Assistant Nursing Officer, Knowledge for Change, Fort Portal, Kabarole District, Uganda

BECKY MASKEW,

BSc Nursing (Adult), Staff nurse, Fairfield General Hospital, Northern Care Alliance, UK

SARAH SULEIMAN

Student Nurse CYP, School of Health and Society, Mary Seacole Building, University of Salford, UK

JANE BOARDMAN, BA Hons, Student Nurse, School of Health and Society, Mary Seacole Building, University of Salford, UK

DEREK BAHANDAGIRA, Registered Nurse, Assistant Nursing Officer, Surgical, Paediatrics, and Diabetes Clinic, Fort Portal Regional Referral Hospital, Uganda

ANGELA MUGUMBA,

Certificate of Registration Midwife, Assistant Nursing Officer, Knowledge for Change, Labour/Gynaecology Ward, Fort Portal Regional Referral Hospital, Uganda

KAYLEIGH THORNTON,

MA, Registered Midwife, Stockport Foundation Trust, UK AUGUSTINE SSEMUJJU, MMed (Obstetrics & Gynaecology), Specialist in Obstetrics and Gynaecology, Fort Portal Regional Referral Hospital, Uganda

YASMIN CAPEL, MBBS, Doctor, Knowledge for Change, Fort Portal Regional Referral Hospital, Uganda ODUR JOE, BSc, Pharmacist, Fort Portal Regional Referral Hospital, Pharmacy Stores

NALUKENGE PROSCOVIA,

Senior Theatre Assistant, Fort Portal Regional Referral Hospital, Uganda

HANNAH RANK, MBChB,

Doctor, Knowledge for Change, Fort Portal, Kabarole District, Uganda

AGNIESZKA SZYMKOWIAK,

MSc, CYP Nurse, Guy's and St Thomas NHS Trust, UK