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462 Index
https://t.me/medicina_free
cutaneous vasculitis, 114, 115
cyclophosphamide, 128
cyclosporine, 112
cytokines, 383
D
Dahlgren and Whitehead’s
model, 319
Darco healing sandal, 212, 213
debulking surgery, 82, 83
decongestive therapy, complete, 86
deep femoral artery, 29
deep femoral artery, 29, 29
deep vein, 15
on plantar surface of foot, 193
valve incompetence in, 18
deep vein thrombosis (DVT), 20, 25,
68–69, 158, 190, 228, 355, 385
deep venous systems, 14
dehydration, 253
dendritic cells, 28
dermatitis artefacta, 168
diagnosis, 170
examination, 169
history, 168–169
intervention, 170–172
investigations, 170
leg wounds due to self‐harm, 169
self‐harm rescue pack, 172
dermatology, 165, 306
dermoscopy, 153
diabetes mellitus, 31, 253, 268
blood tests for, 136
diabetes/associated peripheral
neuropathy, 229
disease process of, 138
diet, 438, 442
ketogenic or anti‐inammatory, 96
and nutritional status, 58, 232
disease‐modifying anti‐rheumatic
drugs (DMARDs), 118, 122
disease pathology, 23, 132, 303
Doppler ABPI reassessment, 276
Doppler ultrasound, 164, 265
dorsalis pedis artery, 270, 271–272
dressing(s), 1, 4, 112–113,
231–232, 286, 372
access to, 8
adhesive, 122
antimicrobial, 155
change, 295, 299, 303, 305, 307
charcoal, 155
choice, 129
electrode, 141
foam, 7
management of, 3
metronidazole gel, 155
prescription costs, 3
primary, 122, 154
product analysis, 6–7
product classication, 4–6, 5
secondary, 122, 154
selection, 171
topical antimicrobial, 122
dressing optimisation scheme/
system (DOS), 6–8
drug‐induced leg ulcers, 155.
Seealso Martorell’s ulcers
cutaneous atypical wounds, 156
leg ulceration in people who
inject drugs, 157–161
medication‐related
ulceration, 155–157
E
early intervention, 84, 227,
266, 344, 360
ecthyma, 172, 173
ecthyma gangrenosum, 173, 174
eczema, 75
elastic arteries, 28
elastic bandage, 358, 358
elastic bandage, static stiness
for, 380, 380
electrode dressing, 141
electrostimulation, 141
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Index 463
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embolism, 32
emollients, 74, 76, 431–434
emotional responses, 290
endothelium, 11, 20, 21, 28,
37, 44, 131
endovenous ablation, 354, 411, 412
end‐stage renal failure
(ESRF), 141, 142
epithelisation, 38
erosive pustular dermatosis
(EPD), 161
compression therapy, 166
dermatitis artefacta, 168–172
diagnosis, 164
dierential diagnoses of, 162
examination, 162–163
intervention, 164
investigations, 163–164
local wound care, 165
oral treatments, 165
patient self‐care, 166–168
pustules and crusted areas to
surrounding skin, 163
self‐management, 167–168
topical treatments, 165
erythrocyte sedimentation rate
(ESR), 73, 117
Escherichia coli, 173
European standard hosiery,
416, 417
European Wound Management
Association (EWMA), 153
evidence‐based clinical
management, 318
evidence‐based practice, 330, 444
excoriation, 264, 367
exercise, 86
mobility and, 209
seated ankle joint exercises with
TheraBand, 210
extrinsic age, 253
exudate management, 130, 154, 234,
366, 369–371, 371–372
F
fabric aid, 429
factitious ulcers. See dermatitis
artefacta
fall(ing)
mechanisms, 201
reasons for, 202
reducing falls risk, 216
screening and assessment
of, 216, 217
screening tools for, 217
family/carer support, 234
fan strapping techniques, 396
fat, 32, 35, 87
cells, 87
lipoedema, 95
non‐lipoedema, 95
pads, 87, 91
femoral artery, 29, 29
brin cu theory, 21, 22
broblasts, 28, 37, 38
brosis, 51, 61, 64, 77, 86,
123, 128, 366
Five Year Forward View, 441
at‐knit garments, 417–418
foam dressings, 6, 7
foot:
arterial pulses of, 271
compression of, 396–397
deformities, 119–120, 120
pump, 17, 17, 193–194
foot issues and mobility, 209
advice and education, 214–215
bespoke or semi‐bespoke footwear
and modications, 214
t and condition of footwear, 212
footwear, 211–212
temporary footwear, 212–214
walking and, 210–211
foot muscle pump (CMP), 189, 194
dysfunction, 190–191, 195–196
failure, 375
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464 Index
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foot orthoses (FO), 206, 215–216
fully custom‐made
functional, 214
o‐the‐shelf functional, 214
visco‐elastic, 216
foot ulceration, medications
causing, 362–364
footwear, 211–212
advice and education, 214–215
bespoke or semi‐bespoke
footwear, 214
t and condition of, 212
modications, 214
temporary, 212–214
tips on selection, 213
footwear, temporary, 212–214
front‐line healthcare practitioners, 2
fungating wounds, 145
G
gabapentin, 114, 145
gait cycle, 193, 205, 206, 207
gait disorders, 208
gate theory, 288–289, 289
Genu valgum, 96
German standard hosiery, 416, 417
giant cell arteritis, 115
goniometer, 196–197, 197
graduated compression therapy,
373, 381, 386
granulomatosis with
polyarteritis, 115
Group A Streptococcus
(GAS), 73, 160
H
haematological disorders, 230
haematology, 106, 133
haemophilia, 230
haemorrhoids, 229
haemostasis, 27, 36
‘hammocking’ eect, 396
handheld Doppler, 267
calculation and interpretation of
ABPI, 273–276
measuring ankle systolic
pressure, 270–273
measuring brachial systolic blood
pressure, 269–270
performing procedure, 268
Hansen disease, 172, 175
Hashimoto disease, 88
healthcare professionals
(HCPs), 107, 435
healthcare resources, data for, 3
heart failure, 52, 230–231
acute deteriorating, 374
chronic, 84, 374, 385
compression in, 386
diuretic medications, 366
heparin, 156
History, Examination,
Investigations, Diagnosis,
Interventions framework
(HEIDI framework), 107
holistic lower limb
assessment, 190, 226
holistic reassessment, 409–411, 410
hosiery, 77. See also
compression hosiery
bespoke, 407, 421
British standard, 416, 417
care, 431
European standard, 416, 417
German standard, 416, 417
made‐to‐measure, 421
o‐the‐shelf, 422
patient education in
understanding, 429–431
self‐care in, 429–431
hydroxycarbamide, 156, 363–364
hydroxycarbamide‐induced
ulceration, 363
hydroxyurea. See hydroxycarbamide
hyperalgesia, 293, 307
hyperkeratosis, 75, 264
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hypersensitivity, 96, 294
hypertension, 31, 231, 365
hypodermitis sclerodermaformis, 73
hypothyroidism, 54, 88
I
immunocompromised conditions,
254
immunosuppressant
agents, 113, 128
inelastic bandage, 358, 380, 392
in advanced practice, 393, 393
static stiness for, 380
infection, 253
infective conditions/infection, 110,
111, 172, 231
Buruli ulcers, 175–176, 176
ecthyma, 173
Hansen disease/leprosy, 175
leishmaniasis, 172, 173, 174
inltration of neutrophils, 110
inamed legs, 69–72
inamed skin, 125
inammatory/autoimmune
disorders, 107
pyoderma gangrenosum, 107–114
rheumatoid arthritis, 118–123
sickle cell disease, 130–134
systemic scleroderma, 123–130
vasculitis, 114–118
inammatory/inammation, 117
bowel disease, 108
conditions, 230
markers, 73
phase of wound healing, 36, 37
vascular disease, 32–33
of veins, 231
iniximab, 112, 118
interface pressure, 378–379
intermittent claudication, 30, 32
intermittent pneumatic
compression (IPC), 81, 397–398
contraindications to, 82
indications and contraindications
for, 398
types of ulceration, 397
International Association for the
Study of Pain (IASP), 285
intrinsic ageing, skin in, 432
intrinsic oxygenation, 253
ischaemia, 114, 129, 290, 306
chronic, 32
critical, 373, 384
limb‐threatening, 360, 373, 384
temporary, 30
tissue, 21, 29, 32, 131, 139
due to vessel damage, 114
ischaemic arteriolosclerosis, 139
K
Kaposi’s sarcoma, classic, 149
keratinocyte carcinomas, 146
kidney disease, 231
Kinesio tape, 80–81
Klebsiella pneumonia, 173
knitting needle syndrome, 334
L
Laplace’s law, 354, 371, 375, 381
laser therapy, 81–82
Leg Club Model, 443
Legs Matters, 234
campaign, 443
coalition, 344, 345
leg ulceration assessment, 226, 227
age, 227
alcoholism, 233
allergies or known sensitivities,
231–232
arterial disease, 248–252
atrophie blanche, 243
cancer diagnosis or
treatment, 230
cardiac vascular history, 230–231
diabetes/associated peripheral
neuropathy, 229
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466 Index
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leg ulceration assessment (Continued)
diagnostic assessment,
265–267, 268
diet and nutritional status, 232
DVT, 228
employment, 235
examination, 238
family/carer support, 234
family history, 227–228
haematological disorders, 230
haemorrhoids and constipation,
229
handheld Doppler performing
procedure, 268–276
hypertension, 231
infection, 231
inammatory and auto‐immune
conditions, 230
lipodermatosclerosis and venous
staining, 245
loneliness and isolation, 234
medical history, 228
medications, 228
mobility, 233–234
pain, 233
phlebitis, 231
pregnancy, 231
previous surgery, 228
previous trauma, 228
psychological status, 235
quality of life, 234
reassessment and recurrence, 276
red ags for urgent treatment of
patients with VLU, 276
respiratory disorders, 230
signs of ankle are, 246
signs of enlarged veins, 240
signs of hyperpigmentation,
staining and hyperkeratosis,
241
skin assessment, 263–264
sleep pattern and behaviour, 232
smoking, 233
stress, 233
varicose eczema, 242
wound assessment, 252–263
leg ulceration, atypical, 106
diagnosis of, 106–107
drug‐induced leg ulcers,
155–161
erosive pustular dermatosis,
161–172
infective conditions, 172–176
inammatory/autoimmune
disorders, 107–134
malignant/neoplastic
wounds, 145–155
metabolic disorders, 134–145
related to RA, 121
leg ulcer management, 318
common views of, 333
healthcare culture of, 335
inuences practitioners’ decision‐
making in, 329–330
problematic culture
within, 332–335
system delays impacts on patient
outcomes, 334
leg ulcer(s), 35
hosiery kits. See compression
hosiery kits
management, 2, 7
pathways, 451
treatment, 2
types, 297
leishmaniasis, 172, 173, 174
leucocytes, 21
leukaemia, 108
lifelong management, 405
assessing for compression
hosiery, 413–415
awareness, 406–407
choosing and prescribing
hosiery, 415–423
choosing compression therapy
system, 423–434
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Index 467
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compression therapy systems,
411–413
empowering patients’ self‐
management for leg ulcer
prevention, 434–438
endovenous ablation, 411
factors inuencing venous ulcer
recurrence, 407–409
holistic reassessment, 409–411
knowledge, sta and train-
ing, 439–441
leg ulcer pathways, 450
patient satisfaction and quality
of life, 450
public health, 441–450
wound care, 405–406
lifestyle factors, 254
limb volume measurement, 64–65
Lindsay Leg Clubs, 234, 346
lipodermatoschlerosis, acute, 70
lipodermatosclerosis, 73, 245, 383
lipoedema, 55, 87. See also
lymphoedema
ankles to demonstrate ’cu’
phenomenon, 91
classication, 94–95
diagnosis, 94
‘hood’ of excess tissue, 93
impact of, 95
key dierences with
lymphoedema and obesity, 89
in practice, 88–94
treatment and management, 95–97
Type III late stage 2with chronic
oedema, 92
Type III, stage 2lipoedema, 90
lipoedema fat, 95
Lively Legs Model, 443
local wound:
care, 129, 165
management, 112–113, 118
loneliness and isolation, 234
long saphenous veins, 16
lower leg wounds, 3
lower limb:
assessment, 190, 226
leadership, 332
lymphoedema, 52
wounds, 1, 172, 405
lower limb ulceration
anti‐inammatory action of
compression therapy, 381–384
case for early intervention, 360
cautions and contraindications,
384–386
clinical management, 360–372
compression hosiery kit, 356
compression hosiery
stockings, 359
compression hosiery wrap, 357
compression of foot, 396–397
compression therapy and work
principle, 372–381
elastic bandage, 358
inelastic bandage, 358
intermittent pneumatic
compression, 397–398
location of ulceration, 396
multidisciplinary
approach, 353–354
recognition of leg ulceration, 355
tools in toolbox, 356–359
treatment of, 353, 386–395
wound bed preparation and
clinical management, 398
lower limb veno‐muscular
pumps, 192
calf muscle pump, 194
calf muscle pump dysfunction,
195–196
foot pump, 193–194
mechanism of action of
VMPs, 194–195
thigh pump, 194
lupus, 114
lymphatic capillaries, 44, 47
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468 Index
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lymphaticovenular anastomosis
(LVA), 82
lymphatic system, 370
anatomy of, 44–45
function of, 43–48
in humans, 46
lymphatic ducts, 45
lymphatic uid, 43, 45, 51, 69, 83
lymphatic liposuction, 83
lymphatic trunks, 44
lymphatic vessels, 47
lymph nodes, 44, 46, 47, 83, 154
lymphocytes, 28, 45
lymphoedema, 3, 44–45, 48, 49, 50,
188. See also lipoedema
adjunct treatment
modalities, 79–82
assessment, 55
causes and exclusions, 60–61
causes of, 52–55
cellulitis and lymphorrhoea
history, 59
clinical examination, 61–64
compression therapy and
assessment considerations, 76–79
diagnosis, 57–59
factors inuence and contribute
to oedema, 54–55
history, 59
management challenges,
66–68, 67–68
measurements, 64–65
obstructive and non‐obstructive
causes of, 50
palliative care, 83–87
prevalence and key facts, 48–51
primary, 49
psychosocial impact, 65, 65–66
risk factors, 52, 53
screening and investigations, 61
secondary, 49
stages, 64
staging and severity, 64
surgery, 82–83
symptoms, 56
treatment, 74–76
types, 49, 50
lymphorrhoea, 7, 68
history, 59
primary, 49, 50, 55, 59
lymphovenous disease, 68
cellulitis, 73
lymphorrhoea, 69, 70
red or inamed legs, 69–72
M
maceration, 263, 264, 369
skin, 69
web‐space, 75
macrophages, 28, 37, 369
made‐to‐measure hosiery, 421
magnetic resonance angiogram
(MRA), 266
magnetic resonance imaging scans
(MRI scans), 154
malignancy, 110, 111, 145
malignant melanoma (MM), 146
amelanotic malignant
melanoma, 151
diagnosis, 153–154
examination, 150–153
history, 149–150
intervention, 154–155
investigations, 153
key risk factors and presentation
of, 147–148
weighted seven‐point
checklist, 151, 153
malignant/neoplastic
wounds, 145–155
malignant ulcer, 145
malnutrition, 74, 124, 128, 173
manual lymphatic drainage (MLD),
79, 80, 86
Marjolin’s ulcers, 146–155, 152
Martorell hypertensive ischaemic
leg ulcers (HYTILU). See
Martorell’s ulcers
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Martorell’s ulcers, 139, 140.
Seealsodrug‐induced leg
ulcers
diagnosis, 140–141
examination, 139
history, 139
intervention, 141
investigations, 139–140
matrix metalloproteinase (MMP),
20, 369, 383
maturation phase of wound
healing, 36, 38–39
mechanical theory, 21
medication:
cause leg and foot ulceration,
362–364
cause or exacerbate swelling in
ankle and lower limb,
365–366, 366
management, 362
medications, 254
Medicines Healthcare Regulatory
Agency, 433
Mental Capacity Act (2005), 170
Mental Health Act (2007), 170
metabolic disorders, 134
calciphylaxis, 141–145
Martorell’s ulcers, 139–141
necrobiosis lipoidica, 134–139
metastatic tumours, 146
methicillin‐sensitive and–resistant
Staphylococcus aureus, 160
methotrexate, 156
metronidazole, 155
micronutrients, 124
microscopic polyarteritis, 115
mild compression therapy, 227,
360
mixed venous/arterial leg
ulceration, 297
mobility, 233–234
and exercise, 209
foot issues and, 209–216
walking and, 205–206
monocytes, 21, 37, 233
monolament testing for
neuropathy, 229
monophasic signal of
ABPI, 273, 274
motivational interviewing (MI),
342
multidisciplinary team
(MDT), 218, 355
muscular arteries, 28
musculoskeletal factors (MSK
factors), 188
allied health professionals as part
of MDT, 218
ankle joint assessment, 196–198
biomechanical factors, 189
lower limb veno‐muscular
pumps, 192–196
management, 205–216
reducing falls risk, 216–217
risk factors, 190–192
Mycobacterium leprae, 175
Mycobacterium ulcerans, 175
myocardial infarction (MI), 230,
231
N
National Institute for Health and
Care Excellence (NICE), 97,
151, 267, 353, 408
National Wound Care Strategy, 4,
329, 344, 442
National Wound Care Strategy
Programme (NWCSP), 106,
192, 360, 406, 442
necrobiosis lipoidica (NL), 134
diagnosis, 137
examination, 135–136
history, 135
intervention, 137–139
investigations, 136
reddened plaques to pretibial
region with, 136
ulcerated, 137
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necrobiosis lipoidica diabeticorum.
See necrobiosis lipoidica (NL)
necrosis, 117, 151
necrotic tissue or foreign bodies, 253
neoplastic or necrotic skin, 125
neoplastic ulcer, 145
neuropathy:
diabetes/associated
peripheral, 229
monolament testing for, 229
pain, 114, 293
neurosignature, 290, 292
neutrophils, 37, 110, 233
NHS Long Term Plan, 343, 441–442
nicorandil, 156, 362–363
nocebo eect, 309, 310
nociceptive pain, 114, 293
nociceptive pain signals, 288
nociceptors, 288, 293
non‐cosmetic liposuction (NCL), 97
non‐lipoedema fat, 95
non‐melanoma skin cancers, 146
non‐painful sensations, 289
non‐steroidal anti‐inammatory
drugs (NSAIDs), 117
non‐venous ulceration, 365
normal venous function, 11–16
blood ow from capillaries to
venules, 13
one‐way bicuspid valves, 14
transportation of blood
around body, 12
nurse‐led bandage regime, 167
Nursing and Midwifery Council
(NMC), 331
nutrition, 254
O
obesity, 31, 89, 203–204, 254
obstructive causes of
lymphoedema, 50
odorous exudate, 370
oedema, 51, 64, 253, 395
o‐the‐shelf hosiery, 422
one‐time ulcer, 131
online dressing optimisation
system, 8
online non prescription
services, 7–9
opioids, 307, 309
organisational change, 339
organisational culture, 7, 332
orthosis, 215
P
pain, 233, 254, 285
alternative tools for
exploring, 302
analgesia, 306–308
assessment scales, 300
biopsychosocial model,
290–292
causes, 292, 296
compression therapy, 308–309
cycles, 295–296
descriptors, 294
experience, 285–287, 301
gate theory, 288–289
impact on people’s lives, 296–297
key management messages,
304–306, 312
management, 114, 129, 298–303,
306–308
psychosocial management,
309–311
questions to understanding
patients’ pain, 298
theory evolution, 287–288
types, 293–295
uncontrolled, 268
palliative care, 83, 385
assessment, 85
compression therapy, 86
end‐of‐life diseases with
lymphoedema, 84
management, 86
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Palliative Care Outcome Scale
(PCOS), 85
palpable purpura, 117
Pascal’s law, 354, 375, 381, 396
Pascal’s principle. See Pascal’s law
pathergy, 108, 110, 111
patient activation:
personal health management
through, 339–340
rationale for, 339
patient activation measure (PAM),
339, 340–341, 341
patient‐centred intelligence, 339
patient education, 76
lymphoedema, 77
in understanding
hosiery, 429–431
patient satisfaction and quality
of life, 450
patient self‐care, 166–168
peau d’orange, 61, 63, 88
peer support groups, 345–346
pentoxifylline, 138, 364–365
people who inject drugs
(PWIDs), 157
diagnosis, 160
drug‐taking history in, 159
examination, 159–160
history, 157–159
intervention, 160–161
investigations, 160
leg ulceration in, 157–161
perforator veins, 15, 16
peripheral arterial disease (PAD),
32, 119, 227, 253, 384–385
recurrence in patients with,
408
6Ps of, 248, 252
peripheral arterial occlusive disease
(POAD), 26, 29–30
peripheral oedema, 268
peroneal tibial artery, 270
personalised care, 134
challenging non‐compliance,
335–337
evidence‐based clinical
management, 318
inuence of condence, courage
and competence, 330–332
inuences practitioners’ decision‐
making, 329–330
key areas of public health
practice, 326
Legs Matter coalition, 345
making eective change, 326–329
negative terminology, 346
patient activation measure,
340–341
peer support groups, 345–346
personal health management,
339–340
positive descriptors, 347
positive language to promoting
positive culture, 346–347
problematic culture within leg
ulcer management, 332–335
public help interventions, 325
social, environmental and
cultural context of health, 319
social prescribing, 342–343
supporting self‐management,
343–345
understanding lived experience,
338–339
wider determinants of
engagement, 324
wider or social determinants of
health, 319–324, 320
PG, acne and suppurative
hidradenitis (PASH), 108
phagocytosis, 37
phlebitis, 228, 231
phototherapy, 138
physical activity, 204–205, 434
Plan–Do–Study–Act cycle (PDSA
cycle), 444–446, 445
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