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Venous leg ulcers are open lesions between the knee and the ankle joint, which occur in the presence of venous insufficiency. There are theories to explain the causes of venous insufficiency, which ultimately leads to venous hypertension and can result in leg ulceration. Although many patients present with evidence of venous hypertension, others do not, except for the manifestation of the ulcer. There are risk factors associated with venous insufficiency and a holistic approach must be taken in order to influence the management approach of venous leg ulceration. This article discusses venous insufficiency as a disease process, and explores the nursing assessment process, when assessing venous leg ulcers related to venous insufficiency.

The management of venous leg ulcers is frequently problematic, usually as a result of the patient's existing co-morbidities, but often because of problems in skin management, such as hyperkeratosis or skin sensitization and resulting contact dermatitis. Good leg ulcer management practice includes skin care, protection from excessive exudate and from potential sensitisers. This article explores how the practitioner can recognize allergic contact dermatitis in a patient with a venous leg ulcer and avoid the use of avoid potential skin sensitizers during management.

Objective: To develop a standardised method of assessing venous ulceration, based on the colour of an ulcer bed and the surrounding skin., Method: This pilot study involved taking three sequential digital photographs during an episode of care and measuring the colour using image analysis software. Ten episodes of care were used for data collection., Results: Based on previous research, a threshold of < or =3 degrees of colour and 3% of saturation was selected to indicate the reliability of the system. The mean of the colour measurements was inside the reliability threshold when measuring an ulcer bed, but outside the threshold for measuring the surrounding skin., Conclusion: The results indicate that the system provides consistent visual representation of a venous leg ulcer.

Currently, no instrument is available to provide an accurate and simple method of monitoring venous ulcer healing in clinical practice. The Pressure Ulcer Scale for Healing (PUSH) tool was developed and validated to monitor the healing of pressure ulcers. During a 2-month study involving 27 venous ulcer patients visiting a chronic wound clinic of a major university, the feasibility of using the PUSH tool to monitor healing was evaluated. The patients were assessed by two Wound Ostomy Continence Nurses using the PUSH tool, where 0 = healed and 17 = worst possible score. The mean score at the initial clinic visit was 12. One month and 2 months later, the mean scores were 9 and 8, respectively. Of the 27 participating patients, 23 had a decrease in their PUSH score over the 2-month period of the study; four of the 23 patients had PUSH scores of zero after 2 months because their venous ulcers had healed. One ulcer did not change and three ulcers worsened and their PUSH scores increased. Based on this study, the PUSH tool appears to be an effective way to monitor healing trends in venous ulcers as well as pressure ulcers.

Much research has been undertaken into the cost-effectiveness of leg ulcer treatments, dressing selections and patient compliance. However, comparatively little research has investigated the effect of leg ulcers on patients' quality of life. This article reviews the literature examining the quality of life of this patient group and the factors that have the greatest negative impact on them.

Poor rates of healing and high rates of re-ulceration are characteristic of venous leg ulcer. The performing of special health-deviation self-care is important for the successful treatment and prevention of this chronic disease. This study aimed to validate a newly designed instrument for the measurement of specific self-care. The "Wittener Aktivitätenkatalog der Selbstpflege bei venös bedingten offenen Beinen" (WAS-VOB) (a catalogue containing self-care activities for venous leg ulcer) was conceptualized on the basis of Orem's theory and on pathophysiological processes. The items were created by using patient interviews (n = 20) and a literature review. An analysis of the reliability was used to reduce the raw scale. The quality of the WAS-VOB was assessed for face-validity (n = 6), feasibility (n = 8), test-retest-reliability (n = 60) and the internal consistency (n = 234). The involvement of patients was based on an informed consent. The WAS-VOB is a self-describing instrument, includes 59 self-care activities and describes those in eight scales which deal with "general compression", "wearing compression bandages", "wearing compression hosiery", "mobility", "temperature", "overload of the venous system", "prevention of skin damage" and "wound healing". The WAS-VOB is practicable and has good psycho-metric characteristics. The test-retest-coefficient (Kendall's tau b) is 0.58, Cronbach's alpha 0.72. The instrument WAS-VOB is suitable for the assessment of self-care deficits.

Venous leg ulcers represent a significant public health problem that will increase as the population ages. The elderly, the most likely to be afflicted by this condition, present the clinician with special challenges. The diagnosis of venous leg ulcers involves taking a careful history, paying attention to the existence of factors that predispose individuals to the development of chronic venous insufficiency. Clinical features of venous insufficiency are important because their recognition allows clinicians to distinguish venous from other chronic ulcers. An essential part of the assessment of all patients with chronic wounds is an evaluation of intercurrent diseases, common in the elderly, which may impact on the wound healing process. Thus, in addition to managing venous insufficiency and the wound bed, all other factors, systemic and local, that may impede healing need to be investigated and corrected if necessary. Social and psychological issues common to all chronic illnesses need to be addressed as well. This holistic approach should be standard practice and is applicable to the assessment and management of all chronic leg ulcers. This often requires coordinating a multidisciplinary team of wound healing caregivers. More work needs to be done to clarify a few issues because areas of controversy persist. Although a great deal is known about the effects of vitamin deficiency on acute wounds, less is known about chronic ulcers. Similarly, the role of vitamin supplementation in managing chronic ulcers needs further study. Guidelines are needed to determine indications for wound culturing. In addition, more study is required to establish the most effective means of obtaining quantitative cultures. However, the relationship between bacteria and chronic wound healing goes beyond simple quantitation and other factors such as bacterial virulence and host resistance. These controversial issues will be reviewed. Treatment and prevention of venous leg ulcers will be discussed in a subsequent article.

Objective: To describe the prevalence, incidence, management, and predictors of venous ulcers in residents of certified long-term-care facilities using the Minimum Data Set., Design: Retrospective cohort study., Setting and Participants: 32,221 residents admitted to long-term-care facilities in Missouri between January 1, 1996, and October 30, 1998., Main Outcome Measures: Version 2.0 of the Minimum Data Set was utilized. Assessment items included selected measures from background information, disease diagnoses, physical functioning and structural problems, health conditions, oral/nutritional status, and skin condition., Main Results: Venous ulcer prevalence on admission was 2.5%. The incidence of venous ulcer development for long-term-care residents admitted without an ulcer at 90, 180, 270, and 365 days after admission was 1.0%, 1.3%, 1.8%, and 2.2%, respectively. The most frequent skin treatments for residents with a venous ulcer were ulcer care, dressings, and ointments. Factors associated with venous ulcer development within a year of admission were diabetes mellitus, peripheral vascular disease, and edema., Conclusion: Venous ulcer prevalence and incidence are greater in the long-term-care population than in the community at-large. Residents with a venous ulcer are likely to have comorbid conditions such as diabetes mellitus, peripheral vascular disease, congestive heart failure, edema, wound infection, and pain. Based on these data, risk factors such as history of leg ulcers, recent edema, diabetes mellitus, congestive heart failure, or peripheral vascular disease should prompt clinicians to carefully plan care that will manage a resident's risk for venous ulcer development.

This article acknowledges the substantial progress that has been made in leg ulcer management in recent years. However, there needs to be greater emphasis on health promotion, quality of life, general patient well being and promoting health within illness. Incorporating health promotion activities within venous leg ulcer management strategies may serve to empower patients to participate more fully in their care. Nurses' awareness needs to be raised to ensure that the assessment process is used as a tool to promote holistic care and not merely as a checklist to provide baseline information on the patient's health status. A series of factors highlighted during assessment are explored to demonstrate the potential for health promotion.

That diabetic plantar ulcers are "round-like" and venous ulcers are "irregularly" shaped is well known. However, these notions have not been quantified or substantiated systematically. In this retrospective analysis, geometric parameters--including area (A), perimeter (p), and shape factor (SF)--of 255 venous and 305 plantar ulcers have been determined using length (L) and width (W) in specific calculation models; these calculations then were compared with computer planimetry. Length was the maximum dimension and width was the maximum dimension perpendicular to length. Results show that venous ulcers, when compared with plantar ulcers, have significantly smaller shape factors and smaller W/L ratios. An optimized calculation model (A = KoLW) then was used, in which Ko was adjusted to minimize root-mean-square (rms) error among venous and plantar ulcers. Values of Ko differed for venous (Ko = 0.67) and plantar (Ko = 0.73) ulcers, with no significant overall paired-differences in actual vs. calculated area. Overall, these models correctly identified 91.8% of venous and 95.1% of plantar ulcer areas within 20% of actual areas. If venous ulcer SF was > 0.35, 3% of the ulcers exceeded the 20% error limit; if SF was < or = 0.35, then 56% exceeded the 20% error. If plantar ulcer SF was > 0.65, no ulcers exceeded the 20% error limit; if SF was < or = 0.65, 15% did. These findings provide quantitative data of absolute and comparative ulcer shapes and clarify the impact of shape on area assessment accuracy when estimated by simple length by width measures.