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Lower Limb and
Leg Ulcer
Assessment and
Management
Lower Limb and
Leg Ulcer
Assessment and
Management
Edited by
ABY MITCHELL
GEORGINA RITCHIE
ALISON HOPKINS
This edition rst published 2024
© 2024John Wiley & Sons Ltd
All rights reserved. No part of this publication may be reproduced, stored in a
retrieval system, or transmitted, in any form or by any means, electronic, mechanical,
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howtoobtain permission to reuse material from this title is available at
http://www.wiley.com/go/permissions.
The right of Aby Mitchell, Georgina Ritchie and Alison Hopkins to be identied as the
authors of the editorial material in this work has been asserted in accordance with law.
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they make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specically disclaim all warranties, including
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Library of Congress Cataloging- in- Publication Data Applied for:
Paperback ISBN: 9781119908210
ePDF: 9781119908227
ePUB: 9781119908234
oBook: 9781119908241
Cover Design: Wiley
Cover Image: © medejaja/Adobe Stock Photos
In remembrance of Hugo
https://t.me/medicina_free
Professor Hugo Partsch, 1938–2023
Doctor, researcher, scientist
A humble and generous mentor
Founder of the International Compression Club
Who ignited for many a lifelong fascination with compression therapy
Thank you
Contents
https://t.me/medicina_free
List of Contributors xiii
Foreword xv
Preface xvii
Acknowledgements xx
Introduction 1
Alison Hopkins and Joseph Montgomery
The Wound Care Burden 1
The Cost of Sub-Optimal Wound Care 3
Classication ofDressing Products 4
Dressing Product Analysis 6
Online Non Prescription Services 7
Conclusion
References 9
CHAPTER 1
Aetiology 11
Aby Mitchell
Normal Venous Function 11
Veins inAction 16
Blood Pressure inVeins andCapillaries 17
Venous Disease 18
Pathophysiology ofChronic Venous Disease 19
Theories ofTissue Damage 21
Chronic Venous Insuciency 23
Risk Factors forVenous Insuciency 24
Arterial Disease 24
9
vii
viii Contents
https://t.me/medicina_free
The Skin 33
Wound Healing 35
Phases ofWound Healing 36
Conclusion 39
References 39
CHAPTER 2
Lymphoedema and Chronic Swelling 43
Caitriona O’Neill and Rhodri Harris
Function ofthe Lymphatic System 43
Prevalence andKey Facts 48
Causes ofand Risk Factors 52
Assessment, Diagnosis andStaging 55
Management Challenges 66
Lymphovenous Disease 68
Treatment 74
Compression Therapy andAssessment
Considerations 76
Adjunct Treatment Modalities 79
Surgery 82
Palliative Care 83
Lipoedema 87
Summary 97
References 97
CHAPTER 3
Atypical Causes ofLeg Ulceration 106
Sarah Bradbury and Kirsten Mahoney
Inammatory/Autoimmune Disorders 107
Metabolic Disorders 134
Malignant/Neoplastic Wounds 145
Drug- Induced Leg Ulcers 155
Erosive Pustular Dermatosis 161
Infective Conditions 172
Conclusion 176
References 177
Contents ix
https://t.me/medicina_free
CHAPTER 4
Musculoskeletal Factors inLeg Ulcers:
AssessmentandManagement 188
Rona Frances Campbell
Risk Factors 190
Lower Limb Veno- Muscular Pumps 192
Ankle Joint Assessment 196
Holistic History Taking Relating toFactors
that Inuence Biomechanical Lower
Limb Function 198
Management 205
Reducing Falls Risk 216
Allied Health Professionals asPart ofthe
Multidisciplinary Team 218
Conclusion 218
References 219
CHAPTER 5
Assessment ofLeg Ulceration 226
Karen Staines and Aby Mitchell
Assessment 227
History Taking 227
Examination 238
Arterial Disease 248
Wound Assessment 252
Skin Assessment 263
Diagnostic Assessment 265
How toPerform aHandheld Doppler 268
Red Flags forthe Urgent Treatment ofPatients
withVenous Leg Ulcers 276
Reassessment andRecurrence 276
Conclusion 276
References 277
x Contents
https://t.me/medicina_free
CHAPTER 6
Holistic Management ofPain 285
Fran Worboys and Alison Hopkins
The Pain Experience 285
Theories ofPain 287
Causes ofPain 292
Types ofPain 293
Pain Cycles: Never- Ending Pain 295
Impact ofPain onPeople’s Lives 296
Causes ofPain 296
Pain Management Solutions: Assessment 298
Managing Pain 303
Conclusion 312
References 312
CHAPTER 7
Personalised Care inLeg Ulceration 318
Alison Hopkins and Charlotte Smith
The Wider or Social Determinants ofHealth 319
Wider Determinants ofEngagement
withTreatment 324
Making Eective Change 326
What Inuences Practitioners’ Decision- Making
inLeg Ulcer Management? 329
The inuence of Condence, Courage
andCompetence 330
A Problematic Culture Within Leg Ulcer
Management 332
Challenging Non- compliance 335
Understanding theLived Experience 338
Support Personal Health Management
Through Patient Activation 339
Patient Activation Measure 340
Shared Decision- Making 340
Social Prescribing 342
Motivational Interviewing 342
Supporting Self- Management 343
Contents xi
https://t.me/medicina_free
Legs Matter Coalition: Raising Awareness
ofLower Limb Conditions 345
Peer Support Groups 345
Using Positive Language toPromote
aPositive Culture 346
Conclusion 347
References 348
CHAPTER 8
Clinical Management ofthe Lower Limb 353
Georgina Ritchie
The Case forEarly Intervention 360
Clinical Management 360
What Is Compression Therapy and How Does it Work? 372
Anti- inammatory Action ofCompression Therapy 381
Cautions andContraindications 384
Considering andCommencing Treatment 386
Location ofthe Ulceration 396
Compression ofthe Foot 396
Intermittent Pneumatic Compression 397
Wound Bed Preparation andClinical Management 398
Conclusion 400
References 400
CHAPTER 9
Lifelong Management 405
Jane Harry
Factors Inuencing Venous Ulcer Recurrence 407
Holistic Reassessment Including Ankle
BrachialPressure Index 409
Endovenous Ablation 411
Compression Therapy Systems 411
Assessing forCompression Hosiery 413
Choosing andPrescribing Hosiery 415
Other Considerations when Choosing a Compression
Therapy System 423
Empowering Patients’ Self- Management
forLeg Ulcer Prevention 434
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