Pinch graft skin transplantation for leg ulcers in primary care

The presence of venous leg ulcers (VLU) is associated with emotional disorders in individuals who have conditions, such as depression, anxiety, and sleeping problems, which result in a reduced perceived quality of life by these individuals. The study aim was to describe the perceived quality of life and associated factors for individuals with VLU. We conducted a cross-sectional study in 22 primary care health centers with a sample of 93 individuals with VLU. The variables collected were the following: perceived quality of life measured with Spanish version of the Charing Cross Venous Ulcer Questionnaire (CCVUQ-e), ulcer severity measured with the RESVECH 2.0 Score, demographic variables, and those related to the healing process. The results showed a mean CCVUQ-e score of 47.4 ± 11.8 points (Mean ± SD), with the most affected dimension being the emotional status, followed by cosmesis, social interaction, and domestic activities. The mean RESVECH 2.0 score was 11.1 ± 3.7 points. An association was found between ulcer-related pain and poorer quality of life ( P < .05, t test) and between erythema in perilesional skin and poorer quality life ( P < .05, t test). The signs of infection and inflammation in the VLUs were as follows: increasing exudate, friable tissue, and biofilm-compatible tissue, which were associated with a poorer quality of life ( P < .05, t test). The multivariate model was statistically significant and explained a variability of 26% in the CCVUQ-e score. This study confirms that wound severity, pain, and signs of infection in VLU decrease the perceived quality of life of individuals with these wounds.

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A survey of the management of leg ulcers in primary care settings in Scotland

Journal of Clinical Nursing ◽

10.1046/j.1365-2702.1998.00124.x ◽

1998 ◽

Vol 7 (1) ◽

pp. 45-50 ◽

Cited By ~ 18

Author(s):

Susan Hickie ◽

Sue Ross ◽

Christine Bond

Keyword(s):

Primary Care ◽

Leg Ulcers ◽

Primary Care Settings

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Pinch Grafting of Chronic Leg Ulcers in Primary Care: Fourteen Years' Experience

Acta Dermato Venereologica ◽

10.1080/000155502320323243 ◽

2002 ◽

Vol 82 (4) ◽

pp. 275-278 ◽

Cited By ~ 20

Author(s):

Rut F. Öien ◽

Anders Håkansson ◽

Bjarne U. Hansen ◽

Mats Bjellerup

Keyword(s):

Primary Care ◽

Leg Ulcers ◽

Chronic Leg Ulcers

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Publication of UK NICE Clinical Guidelines 168 has not significantly changed the management of leg ulcers in primary care: An analysis of The Health Improvement Network database

Phlebology The Journal of Venous Disease ◽

10.1177/0268355518805658 ◽

2018 ◽

Vol 34 (5) ◽

pp. 311-316 ◽

Cited By ~ 8

Author(s):

Huw OB Davies ◽

Matthew Popplewell ◽

Gareth Bate ◽

Ronan P Ryan ◽

Tom P Marshall ◽

...

Keyword(s):

Primary Care ◽

Clinical Guidelines ◽

Health Improvement ◽

Leg Ulcers ◽

Network Database ◽

Below The Knee ◽

Before And After ◽

The Health Improvement Network ◽

New Diagnosis ◽

The Impact

Background NICE Clinical Guidelines (CG) 168, published in July 2013, recommend specialist vascular referral for all leg ulcers, defined as a break in the skin below the knee that has not healed within two weeks. Aim To examine the impact of CG168 on the primary care management of leg ulcers using The Health Improvement Network database. Methods An eligible population of approximately two million adult patients was analysed over two 18-month periods before and after publication of CG168. Those with a new diagnosis of leg ulcers in each time period were analysed in terms of demographics, specialist referral and superficial venous ablation. Results We identified 7532 and 7462 new diagnoses of leg ulcers in the pre- and post-CG168 cohorts, respectively. Patients with a new diagnosis of leg ulcers were elderly (median age: 77 years both cohorts) and less likely to be male (47% both cohorts). There were 2259 (30.0%) and 2329 (31.2%) vascular service referrals in the pre- and post-CG168 cohorts, respectively (hazard ratio, 1.05, 95% CI: 0.99, 1.11, p = 0.096). The median interval between general practitioner diagnosis and referral was 1.5 days in both cohorts. Patients from both cohorts who were referred for a new diagnosis of leg ulcers were equally likely to receive superficial venous ablation. Conclusions Disappointingly, we have been unable to demonstrate that publication of NICE CG168 has been associated with a meaningful change in leg ulcer management in primary care in line with guideline recommendations.

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General practitioners’ perceptions of their role and their collaboration with district nurses in wound care

Primary Health Care Research & Development ◽

10.1017/s1463423618000464 ◽

2018 ◽

Vol 20 ◽

Author(s):

Anne Friman ◽

Desiree Wiegleb Edström ◽

Samuel Edelbring

Keyword(s):

Primary Care ◽

General Practitioners ◽

Wound Care ◽

Healing Time ◽

County Council ◽

Leg Ulcers ◽

Negative Consequences ◽

Individual Interviews ◽

Structured Care ◽

District Nurses

AbstractAimTo explore the perceptions of general practitioners (GPs) regarding their role and their collaboration with district nurses (DNs) in the management of leg ulcers in primary healthcare.BackgroundEarlier research regarding the treatment of leg ulcers in a primary care context has focussed primarily on wound healing. Less is known about GPs’ understandings of their role and their collaboration with DNs in the management of leg ulcers. Since the structured care of patients with leg ulcers involving both GP and DN is currently rather uncommon in Swedish primary care, this study sets out to highlight these aspects from the GP’s perspective.MethodsSemi-structured individual interviews with 16 GPs including both private and county council run healthcare centres. Thematic analysis was used to analyse the data.ResultsFour themes were identified. The first theme: ‘role as consultant and coordinator’ shows how the GPs perceived their role in wound care. In the second theme: ‘responsibility for diagnosis’ the GPs’ views on responsibility for wound diagnosis is presented. The third theme: ‘desire for continuity’ is based on the GPs’ desire for continuity concerning various aspects. In the fourth theme: ‘collaboration within the organisation’ the importance of the organisation for collaboration between GPs and DNs is presented.ConclusionsThe GP’s often work on a consultation-like basis and feel that they become involved late in the patients’ wound treatment. This can have negative consequences for the medical diagnosis and, thereby, lead to a prolonged healing time for the patient. Shortcomings regarding collaboration are mainly attributed to organisational factors.

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Pinch Grafting of Leg Ulcers in Primary Care

Acta Dermato Venereologica ◽

10.1080/000155598442737 ◽

1998 ◽

Vol 78 (6) ◽

pp. 438-439 ◽

Cited By ~ 19

Author(s):

Rut F. Öien, Bjarne U. Hansen,

Keyword(s):

Primary Care ◽

Leg Ulcers

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E-survey on venous leg ulcer among Dutch dermatologists

Phlebologie ◽

10.12687/phleb2144-6-2013 ◽

2013 ◽

Vol 42 (05) ◽

pp. 270-274 ◽

Cited By ~ 1

Author(s):

K-P. de Roos ◽

R. J. M. Vogels ◽

H. A. M. Neumann ◽

S. W. I. Reeder

Keyword(s):

Leg Ulcer ◽

Therapeutic Regimen ◽

Skin Transplantation ◽

Leg Ulcers ◽

Venous Leg Ulcer ◽

Good Insight ◽

Overall Response ◽

Venous Leg Ulcers ◽

Mean Time ◽

Insight Into

SummaryAim: To get insight into the frequency of venous leg ulceration in the Dutch dermato-logic practice, and into how this profession treats this disease.Design:Material and Methods: An e-survey was conducted. To all Dutch dermatologists and residents dermatology an email was sent with an online link to a questionnaire on venous leg ulcers.Results: The overall response was 30 %. 83.5 % of the doctors usually treat their patients according to the guideline. The dermatologic practice consists on average of 73 patients (range 0-500; SD 93) with leg ulceration, and yearly 54 new leg ulcer patients (range 0-300; SD 50) are seen. 65 % of the patients are women, 80 % is more than 45 years of age and 55 % is older than 65. Of all ulcers, 77 % has a venous aetiology, of which 59 % has a primary cause. Mean time to heal is 74 days (range 4-200; SD 39). Per year, dermatologists admit on average 7 patients (range 0-50; SD 11) because of leg ulceration. Eventually, 47 % of the admitted patients are treated by skin transplantation.Conclusions: This questionnaire gives a good insight in the epidemiology, and the diagnostic and therapeutic regimen for patients with venous leg ulcers in Dutch dermatologic practice.

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