Speeding recovery from venous leg ulcers to reduce potentially complex side effects

04 Jul Speeding recovery from venous leg ulcers to reduce potentially complex side effects

Covid-19 has impacted healthcare delivery around the world. The pandemic turbo charged more remote healthcare diagnostics and consultations, leading to the faster adoption of innovation and increasingly non-pharmaceutical interventions. However, healthcare systems need to continue accommodating patients that are unwilling or unable to adapt to self-service healthcare systems.

Complex conditions

Elderly people are perhaps the most vulnerable during the shift to more digital and remote healthcare solutions. They may struggle to adapt to new processes and lack the skills and ability to access such care. Elderly patients are also more likely to suffer with chronic conditions, like venous leg ulcers (VLUs).

VLUs are chronic skin ulcers typically caused by continuous venous hypertension or chronic venous insufficiency. The risk of developing a VLU increases with age, with prevalence doubling among those older than 65^[1]. VLUs take months to heal, while some never heal at all^[2], and recurrence rates are high^[3] increasing the risk of infection.

Managing infections

It has been reported that^[4], of more than 500 patients suffering with leg ulcers, almost ten percent developed infections. Other research found higher levels of infected VLUs among patients: De Souza reported an infection rate of 27 percent^[5], while Rondas et al  found 22 percent of VLUs were infected.^[6]

Infected VLUs can cause fever, increased pain, cellulitis, necrotic tissue, and purulent exudate with or without odour^[7]. For healthcare professionals, the priority is to address the infection because it interrupts wound healing. To address a wound infection nurses will sometimes use antiseptic dressings, though the most common treatment is a course of anti-biotics.

A cocktail of concern

Healthcare systems are becoming more reluctant to prescribe anti-biotics due to concerns over resistance. Anti-biotic resistance in germs has seen the emergence of ‘superbugs’ such as methicillin-resistant Staphylococcus aureus (MRSA). These types of infections can be challenging to treat and are becoming an increasing cause of disability and death around the world. New strains of bacteria may also emerge that cannot be treated by any existing anti-biotics. For example, there were more than 150 outbreaks of MRSA in UK hospitals in the first three months of 2022 alone.^[8]

Elderly patients with medical complications and a history of regular anti-biotic treatment may have built up a resistance. This puts them at a higher risk of receiving a negative outcome from treatment with these drugs than others. Patients at risk of VLUs can therefore be more vulnerable to infections but less able to address these through the existing standard of care.

Alternatives to pharmaceutical intervention

Medical technology (MedTech) is helping to address chronic conditions with less reliance on anti-biotics. VLU patients have recently been trialling the geko™ device alongside standard of care. Initial results have suggested increased blood flow from the geko™device is healing VLUs faster than standard of care alone.  Patients experienced the closure of wounds more quickly – these faster healing wounds have less time to be exposed to the risk of infection.

A new world of healthcare

The adoption of digital solutions in healthcare systems may mean more remote treatment for patients, but this should not be at the expense of the individual care that specific patients require to address hard to heal conditions such as VLUs.

Embracing MedTech innovation is a significant opportunity for healthcare systems to demonstrably address wide reaching and chronic conditions that significantly reduce the quality of life of patients.  A new way of delivering healthcare should have space for new thinking in treating conditions with innovation that may not always be pharmaceutical.  MedTech has the potential to address issues that are difficult to resolve with current standard of care alone.

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References:

1. 1. NHS England. Overview: Venous Leg Ulcer. 2019. Available from: https://www.nhs.uk/conditions/leg-ulcer/
   2. Guest JF, Fuller GW, Vowden P. Venous leg ulcer management in clinical practice in the UK: costs and outcomes. Int Wound 2018;15:29–37
   3. Finlayson K, Wu M-L, Edwards HE. Identifying risk factors and protective factors for venous leg ulcer recurrence using a theoretical approach: a longitudinal study. Int J Nurs Stud 2015;52:1042–51
   4. Bui, UT, Edwards H, & Finlayson K (2018). Identifying risk factors associated with infection in patients with chronic leg ulcers. International wound journal, 15(2), 283–290. doi.org/10.1111/iwj.12867
   5. De Souza JM, Vieira ÉC, Cortez TM, Mondelli AL, Miot HA, Abbade LPF. Clinical and microbiologic evaluation of chronic leg ulcers: a cross–sectional study. Adv Skin Wound Care. 2014;7:222–227. [PubMed] [Google Scholar]
   6. Rondas AALM, Schols JMGA, Stobberingh EE, Halfens RJG. Prevalence of chronic wounds and structural quality indicators of chronic wound care in Dutch nursing homes. Int Wound J. 2015;12:630–635. [PMC free article] [PubMed] [Google Scholar]
   7. Wound Source. Complications of Venous Leg Ulcers. 2019. Available from: https://www.woundsource.com/blog/complications-venous-leg-ulcers
   8. GOV UK. MRSA bacteraemia: monthly data by location of onset. 2022. Available from: https://www.gov.uk/government/statistics/mrsa-bacteraemia-monthly-data-by-location-of-onset