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Venous ulcer (ulcus cruris venosum) wound management “Compression is priority number one”

Issue 03/2016

Whether it is diabetic feet , decubiti, open abdominal wounds, or venous ulcers – Christiane Kanis from Serimed GmbH und Co. KG in Zeulenroda treats a wide variety of wounds every day. And, even though she focuses on the patients’ indications,
the certified wound manager always considers their general well-being.

“With Ms. Schlegel , I can tell straight away if she’s been under a lot of stress,” says Sister Christiane, because her patient’s wound on the inside of her lower left leg regularly reopens. Doris Schlegel , who is in her early 60s, has lived with a recurring venous ulcer for 14 years. Following a complex fracture, she experienced wound healing disorders after surgery, which were exacerbated by venous insufficiency. She developed a classic mixed ulcer.
Sister Christiane has often noticed the special link between the skin and the psyche. “Patients who have had ulcers for many years frequently suffer from serious psychological effects too. Many also have edematous legs and sometimes have problems walking. A few hardly dare to go out in public any more – some don’t even show their leg ulcer to their physician,” says the certified wound manager.

The wound nurse as a “carer”

Christiane Kanis from Serimed GmbH & Co. KG, wound manager in the Thuringia/Vogtland wound network.
Christiane Kanis from Serimed GmbH & Co. KG, wound manager in the Thuringia/Vogtland wound network.

Listening to patients, taking them seriously, building up trust – these are usually the first steps Christiane Kanis takes when she advises, instructs, and treats wound patients in her job as a wound manager in the Thuringia/Vogtland wound network. “The wound networks help to ensure that patients receive interdisciplinary treatment and care from all specialist areas. These include family physicians, surgeons, dermatologists, and vascular surgeons,” she explains. “The physicians treating the patients determine the treatment concept alone or in consultation with the wound nurse. The wound nurse is then responsible for implementing it – in the practices, care homes, and during home visits. We play the role of a ‘carer.’”
Sister Christiane has worked in her profession for 32 years. Has the way in which wound patients are treated changed in this time? “Loads!,” she says. “Just think of all the progress made with regard to wound dressings and compression therapy systems. Today, high-quality dressings can be left on the wound for much longer thanks to their effective exudate management. If all parameters are right , wound treatment is much easier, and much more successful , than before.”
However, she goes on to say that it is always important to provide patients with comprehensive treatment. “For example, at first , Ms. Schlegel was only treated from a trauma surgery perspective,” says the wound manager. “Her venous condition was not taken into account until she came to our wound consultation four years ago, when she finally received the compression she needs.”

Practical compression stocking system for ulcers

Top: Damaged tissue is carefully removed from the leg ulcer.
Top: Damaged tissue is carefully removed from the leg ulcer.

Most ulcers on the lower leg treated by Sister Christiane are caused by chronic venous insufficiency. “These ulcers are relatively easy to treat. Compression is priority number one,” she says.
In the case of venous ulcers that are weeping heavily, exudate management with special wound dressings is of primary importance, but it is always combined with a compression bandage to decongest edematous legs too. “In the early stages, it’s especially important to properly apply a good-quality short-stretch bandage with padding on the inside. The nursing staff would ideally do this,” says Sister Christiane. “As soon as the wound is in the granulation phase and the edema has subsided, compression stocking systems for ulcers can also be used.” The benefits of these systems are obvious to the wound manager: “The compression stockings exert constant therapeutic pressure, while the liner effectively secures the wound dressing, particularly at night when the patient can get by with more gentle compression.” She has positive experiences of the VenoTrain ulcertec. “The stocking fits well , lasts a very long time, and is easy for patients to handle.” In the maintenance phase, she advises them to continue wearing medical compression stockings. “Unfortunately, patient compliance often reduces significantly as soon as the ulcer has closed again,” says the wound manager with regret. “A large number of relapses could be avoided with rigorous follow-up treatment ,” she continues.
In addition to compression therapy, skin care also plays a major role for ulcer patients. “In the case of relapses in particular, the skin over the wound becomes very rough and is more sensitive to bumps, rubbing, and sweat. That’s why good skin care that’s customized to suit the individual patient is very important. It’s also crucial to maintain a positive attitude to life and reduce stress.”

Pictures: Ralph Kunz