Picture of an leg ulcer

Case: An 8-year leg ulcer challenge

The patient’s wound history presents a challenging case involving a 77-year-old man with a longstanding leg ulcer. This individual, suffering from mental illness, had been struggling with this wound for eight years without any signs of healing, as it remained stuck in the inflammation phase. The situation was further complicated by the inability to control the vast amounts of wound exudate, which constantly leaked onto the patient’s clothes, bandages, and sheets. Consequently, the patient’s overall quality of life was severely impaired, and the healthcare provider was left feeling helpless, having exhausted all available treatment options.

This case underscores the need for effective patient care to address chronic wounds and improve the well-being of patients in similar situations. Studies confirmThe impact of chronic venous leg ulcers: a systematic review. National Library of Medicine that challenges with leg ulcer leakage and odour can lead to social isolation, depression, low mood, and diminished self-esteem.

Symptoms and causes of venous leg ulcers

The symptomsSymptoms: Venous leg ulcer. NHS of a venous leg ulcer include pain, itching, swelling with occasional eczema and scaling in the affected leg. A venous leg ulcer often develops on the lower leg, around the ankle, where discoloured or hardened skin around the ulcer and exudate may also be present.

Phases in the wound healing process

The inflammation phase
This starts simultaneously as the wound develops and is the first step in the healing process. Next, the inflammation phase means the wound is cleaned, aided by the body’s white blood cells.

The proliferation phase
The proliferation phase is when new tissue is formed. The signs of inflammation disappear, and the wound becomes bright red and looks healthier as new blood vessels grow at the surface.

The maturation phase
The final stage can last for more than a year, depending on the size and nature of the wound. The skin’s collagen is strengthened during this period, and the bright red scar fades.

phaeses in wound healing process for leg ulcer

When choosing a dressing, it is essential to consider the stage of the wound healing process. Dressings should be selected based on wound location, size, exudate level, presence of infection, and surrounding skin properties.

Method and Treatment

Wound exudate under normal circumstances is beneficial to wound healing because it contains many components, such as biochemical modulators, growth factors and cells, which are intimately involved and beneficial to the healing process. However, in some hard-to-heal wounds, dysfunction and prolongation of normal phases can lead to further tissue damageExudate: Friend or Foe? PNCR around the wound area.

To enhance the wound healing process, the objectives for managing this leg ulcer were established with the aim of:

  • Reduce the exudate and oedema
  • Achieve an undisturbed healing process and prevention of damage to peri-wound skin
  • Prevent infection during treatment
  • Decrease associated malodour and pain
  • Obtain closure of the wound
  • Prevent recurrent ulceration
  • Improved quality of life for the patient
yellow fibrin and wound cleaning on leg ulcer

 

Yellow fibrin was carefully removed before the dressing was applied

Cleaning and caringImplementing TIMERS: the race against hard-to-heal wounds, Journal of Wound Care for the wound area is crucial in treating venous leg ulcers. A biofilm can prevent healing, and mechanical wound cleaning is recommended to remove wound debris. To remove devitalised tissue from a wound, debridement using a blade or scissors is necessary. This should only be performed by a licensed clinician qualified to practice this technique.
Pain relief is also essential during wound cleansing. An assessment of any pain the patient feels should be carried out using a validated pain scale.

absorbent dressing for exuding leg ulcer

Chosen dressing for the wound

In this case, our superabsorbent in DryMax Super was used as a primary dressing. These dressings can be stacked on top of each other, thus handling the worst fluid peaks that can occur when the wound is out of the inflammation phase.

Dressing changes depend on the exudate amount and wound type. Infected or highly exuding ulcers require more frequent changes. Effective dressings reduce the frequency of changes and promote healing. Superabsorbent dressings that encapsulate the exudate and keep the surface of the dressing dry are the ideal choice for use with compression therapy. Dressings with great absorptive capacity can also help prevent maceration, leakage, and odour.

compression therapy on venous leg ulcer

The treatment was combined with compression therapy

Venous leg ulcers are caused by damaged venous valves in the legs, which result in impaired blood and lymph circulation. This leads to oedema, a swelling caused by fluid build-up in the lower limbs. To reduce oedema, compression therapy is recommendedSimplifying venous leg ulcer management: consensus recommendations. woundsinternational.com.
Counteracting the oedema is the most critical aspect of treatment. Therefore, initial non-invasive imaging with venous duplex ultrasonography, arterial pulse examination, and ankle brachial pressure index measurement is recommendedNoninvasive Arterial Testing: What and When to Use. National Library of Medicine for all patients with a suspected Venous leg ulcer.

damaged valves leading to venous insuffiency and leg ulcer

Compression therapy improves venous return, reduces swelling in the lower leg, and reduces leakage from the exuding wound. A reduction in wound exudate facilitates improved peri-wound skin condition. In addition, correct exudate management will extend dressing wear time and reduce nurse visits.

 

Outcomes:

Leg ulcer in inflammation phase

Day 1-30, Inflammation phase:

Absorbest DryMax Super dressing was used to manage the copious amounts of exudate.

  • Better moisture balance allowed healing
  • The wound dressing worked optimally, along with compression therapy
  • Wound fluid was transported efficiently from the wound
  • Maceration was minimised
  • No infection during treatment
  • Dressing changes reduced to once a week

 

 

leg ulcer wound in proliferation phase

Day 60, Proliferation phase:

Absorbest DryMax Super dressing was used. The nurse felt confident and safe using the superabsorbent dressing and didn’t want to change. Alternatively, a superabsorbent Foam dressing could have been appropriate for absorbent and protective properties.

  • Exudate was reduced but still present; ideal moisture level maintained
  • The wound was protected to avoid disruptions in the healing process
  • Patient accepted the uncomplicated wound regime
  • Little pain associated with dressing changes
  • Sensitive, peri-wound skin was protected
  • The wound was contracting
leg ulcer wound in maturation phase

 

Day 150, Maturation phase:

To keep the moisture balance, a border product can be used in this stage, with ceased exudate levels.

  • Wound area and depth significantly reduced
  • Healed wound will continue to be weakerSimplifying venous leg ulcer management: consensus recommendations. woundsinternational.com (80 %) and need continuous protection
  • Patient’s life changed; odour in the home disappeared, improvement in confidence and quality of life

Conclusion

In this case, the patient and the clinician rated the fluid handling improved with the superabsorbent dressing, achieving the primary objective of wound exudate management whilst also allowing undisturbed and preventing damage to the peri-wound skin. A result was a reduced need for clinic attendance, which freed up valuable clinic space for other patients and reduced inconvenience for the patient.

absorbest-drymax-super-made-in-sweden_small

A superabsorbent primary dressing

Experience the difference and compare the outcome with our superabsorbent dressing. Designed to create a simple wound healing process and optimal healing environments to support clinicians giving quality care.

  • A dressing enables longer wear time and fewer dressing changes
  • For use on exuding wounds, works well under compression
  • Available on the NHS Supply Chain and Drug Tariff

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A guide to manage and treat leg ulcers

Promoting treatment of problematic leg ulcers

What are the characteristics of different leg ulcers, and how can we promote the healing of problematic ulcers? Treatment measures, phases of healing, cleaning, and appropriate dressings. Our complete guide to leg ulcers focuses primarily on venous ulcers, from cause and origin to the healing process and aftercare.

Download the guide now

Article references

“The impact of chronic venous leg ulcers: a systematic review”. National Library Of Medicine.

Symptoms venous leg ulcer. NHS

Exudate: Friend or Foe?, PNCR

TIMERS: the race against hard-to-heal wounds. Journal of Wound Care

Harding K, et al. Simplifying venous leg ulcer management, Consensus recommendations. Wounds International 2015. www.woundsinternational.com

“Four stages of wound healing” woundsource.com