Venous ulcer……..any advice ???

[recall]

My Dad has an ulcerated area on the front of his leg, roughly 2" x 3" in size. It began with a rash that he scratched, breaking the skin. This scabbed over, and now is an ulcerated area, with green slough, and has that leg ulcer smell about it. We believe that the rash was initially caused by a drug reaction and was all over his body, but has since been diagnosed as Venous eczema. The GP has examined it, and prescribed a steroid cream and E45. My Dad also has Claudication. Do you think it would help him to have graduated support bandaging/stockings ? or is the claudication contra indicatory ? Should I contact the surgery and ask for a Nurse to manage the wound ?

Any help gratefully received ?

Bump

Anyone ?

Yes. If he has an ulcer and has underlying vascular issues he needs specialist tissue viability input sooner rather than later.

Definitely ask for a nurses input. There may be a leg ulcer clinic in your area if not the practice nurse or district nurse if housebound.

Dont use compression stockings as if it was aterial ulcer they are contraindicated.
He would need a doppler assessment to be sure on the ulcer type.

But as the wound hasnt got a granulating wound bed (healthy skin) it needs dressing either way asap.

Not very good input from GP by your description .
GP needs to arrange regular input from nurse .

Good luck .

Hi. I would ask for him to be referred to a vascular consultant, initially to decide whether it's venous or arterial. My mum had the same thing and the GP wasn't doing much until I insisted she was referred. She had quite a few tests and they found a big blockage in her leg arteries. They gave her a few months to see if it healed up and the nurse dressed it regularly but no compression. If it hadn't healed she would have had to have bypass surgery. My mums ulcer was very painful, not sure if this is more common with arterial.

The things that seemed to help heal it are that she gave up smoking. Also, I got her antioxidants and zinc to take. I also got a CD but can't remember the name and it was about visualising blood flow to the area. Think it's used with diabetics.

Thank you all so much for your advice.

I put a load of the E45 cream on it today, and then just lightly lay a a non adherent dressing over the top. After 12 hours, we took it off and there was loads of green stinking stuff.

I am convinced that the ulcer is infected, so I am taking him to see a different GP tomorrow. I will ask him to swab it, and refer us for further help. I found out that the steroid cream is Betnovate ointment. I just don't think that it is being managed properly. It doesn't seem right to be applying those creams to an open wound with no dressing. Mum said that the Chiropodist did the doppler test and it was him that diagnosed venous rather than arterial.

Im not sure the chiropodist would do a full doppler examination. Definitely see the gp today or practice nurse. It needs swabbing and referring on. Ask for a district nurse wound clinic.
Not sure where you live but im sure most pct have to offer something.

Usually only see the vascular team if its a non healing ulcer. The sooner she is seen the better. The cream may protect the skin around the ulcer but certainly wont clean the wound bed. Green Slough needs specific dressings to lift it.

Let us know how you get on. Good luck

what scoobdoob says.

please bear in mind that the GP sounds like a problem and you need to find a way round that ,otherwise your father will just get left in the system and deteriorate .
eg you ask for referral to district nursing team ,or vascular specialist or whatever and the GP might do that ,and it might take weeks ( or even a week ) during which time the infection will be getting worse .

I don't know your local circumstances but I think if it were me I'd try the GP again stressing urgency and need for immediate attention , if that doesn't work I'd see if there's a practice nurse who could help . Now or tommorrow ,not next week .

And if none of that works ie gets the leg seen and treated for infection today or tomorrow I'd take him to A&E .

Makes me soooo cross ,if this were a baby would they be so offhand ?

Thanks?I went with him this morning, and he wasn't even able to see a GP, they run a morning clinic with a Practice Nurse and a GP, and you get to see either. Anyway, she has referred him to the Ulcer Clinic, and in the meantime given him some gel to put on the sloughy area, and then a foam dressing 10cm x 10cm. I told her it stank and it had green stuff oozing and asked for it to be swabbed. She said that all ulcers contain bacteria so no point swabbing it, and it didn't look clinically infected. They always smell and have green stuff coming off them. I'm not sure about that, but will ask again at the ulcer clinic.

After 24 hours of having his ulcer dressed just with a glob of E45 by me, my Dad said he was pain free for the first time in months last night He has just endured a week's coach Holiday and was in total agony at times. I am furious with his GP for allowing this, and cross with myself for not acting sooner

Thank you all so much for your advice, it was great because having read through it, I was able to articulate it much better to the Nurse this morning on his behalf.

Ah dont be cross with yourself. If the gp doesnt know, how should you know!
The gel (maybe intrasite) should lift the slough. She is right to a degree that all ulcers contain bacteria but I think I would swab it anyway as a base line.

Leg ulcer clinics are great as they are doing these all the time. With experience you can normally have a good idea if its arterial or venous but a doppler exam would be carried out to dictate treatment. Its a quick easy test.