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.

Venous leg ulceration and graduated compression.

Venous leg ulceration is the most common type of ulceration. Incompetency of the valves in the leg results in raised venous pressure which gives rise to the signs and symptoms of venous hypertension. The application of compression bandage therapy remains the cornerstone of treatment in the healing of venous leg ulceration. Application of the correct level of pressure to reverse venous hypertension is essential for such therapy to be successful and practitioners need to be trained in assessment and application techniques to ensure that the recommended level of pressure is applied without causing adverse problems and risks to the patient.

Use of compression hosiery in chronic oedema and lymphoedema.

The management of chronic oedema is a continuing partnership between patient and practitioner and accurate diagnosis and treatment planning are essential to control the condition in order to prevent complications and optimise the patient's quality of life. A paucity of funding, lack of knowledge and confidence on the part of practitioners and widely varying access to services means that many patients face barriers to gaining appropriate treatment. Nurses in many spheres will come across patients with some form of chronic oedema. The following article describes the types and causes of chronic oedema and lymphoedema and explores the use of compression hosiery as one facet in management of the condition. Patient education and the role of the practitioner are also highlighted to develop awareness of the need for adequate preparation of a patient to facilitate concordance and self-management of their condition.

Honey in wound care: effects, clinical application and patient benefit.

The use of honey in wound management has enjoyed a resurgence. This is largely due to the growing clinical problem of antibiotic-resistant bacteria and the combined difficulties for the practitioner in managing chronic wound types, such as burns, leg ulcers or surgical wounds, that may become infected, for example, with methicillin-resistant Staphylococcus aureus or Pseudomonas. The associated costs of treating such wounds are escalating as a result. While the use of honey as a wound dressing has been recognized, at least since Egyptian times circa 2000 BC, it is only more recently, due to the development and licensing of modern honey wound dressings, that such dressings have become more widely available and used in wound management. This article focuses on the use of honey in the treatment of infected wounds and burns. It will examine the effects of honey at the wound bed and its clinical applications, along with the current dressings available. Also discussed are the practical considerations, if, like any wound dressing, honey is to be used safely, appropriately and for the benefit of the patient.

Wound management to encourage granulation and epithelialisation.

Practitioners working in a variety of clinical areas encounter patients with granulating and epithelialising wounds. Successful management relies on an understanding of the underlying physiology of wound healing, comprehensive assessment and appropriate choice of dressing. This paper looks at wound care in epithelialising wounds.

The properties of hydrogel dressings and their impact on wound healing.

In recent decades, the management of difficult wounds has been enhanced by the introduction of amorphous hydrogels. This paper examines reports in the literature on the outcomes of studies into the efficacy of this group of dressings, discusses the types of wounds that are most suitable for hydrogel application and poses questions that merit further investigation.