Time to refocus on the principles of lower limb ulceration management

What is it about?

This issue sees the launch of the EWMA document Lower leg ulcer diagnosis and principles of treatment. This document is the result of a comprehensive review of the literature led by an expert editorial panel and provides an overview of lower leg ulcers from diverse perspectives. The document includes the latest evidence related to: ageing and acute wounds; infection; vascular assessment and treatment; leg oedema; atypical wounds; a checklist for assessment; compression therapy; local wound treatment; patient perspective and economic burden. Importantly the document recommends that “every patient with a lower leg ulcer should be assessed at the first appointment (also in the emergency setting) for infection, ischaemia, diabetes, causes of leg oedema, possible atypical causes or pressure injuries”. There is a continued need to keep the issue of lower limb ulceration to the fore of policy development, education and resource allocation. Patients should be assessed early by clinicians educated in such assessment; treatment should be initiated at the earliest point possible and healing outcomes recorded. Including the patient perspective is central to understanding the means through which we can improve practice and outcomes. Patients know what works; they know what is acceptable and they are the ones who benefit or suffer based on the standard of care they receive. We owe it to our patients to continue to advocate for them and maintain current services and develop new ones. This document will help us to do so. The document includes six recommendations for research and practice. Throughout the document the level of evidence to support practice is provided and clearly identifies any gaps for further research. The next step is to implement the recommendations and ultimately improve the lives of those impacted by lower limb ulceration.

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