Prescribing for the management of venous leg ulceration

Leg ulceration affects between 0.6% and 3.6% of the population,¹ with 28–85% of ulcers owing to venous insufficiency.^2,3,4,5 Venous leg ulceration can have a profound negative impact on quality of life in terms of pain, malodour and leakage, impaired mobility, anxiety, sleep disturbance and social isolation,⁶ and care is costly for the NHS.⁷ Most patients with leg ulcers receive care provided by community nurses,⁶ thus nurses either prescribe, or are heavily influential in the prescribing decisions, for these patients.

Venous leg ulceration is a chronic long-term condition characterised by one or more lesions in the lower limb, owing to high pressure of blood in the leg veins.⁸ In the venous circulation, blood flows towards the heart in response to increased pressure from the heart's pumping combined with calf and foot-pump mechanisms, which function when the ankle is flexed (during walking, for example). Back flow is prevented by a series of valves within the deep, superficial or perforator vein systems, but failure of these valves can cause venous overload.⁹ Some people are born with poor valves, while others acquire valve damage following venous thrombosis, limb trauma or reduced mobility from illness, ageing or through an occupation that involves long periods of standing. When these valves fail to close properly, backflow pressure leads to increased pressure within the veins. It is not known exactly how this venous hypertension leads to skin breakdown, but eventually the skin may fail to heal following an injury or it may break down spontaneously.