The management of leg ulcers and patient
concordance with treatment are complex areas
that may affect patient outcomes and quality of
life. If healthcare professionals are to deliver
quality care, they need to understand fully the
patient experience of living with a leg ulcer.
This includes an awareness of physical factors,
including pain, odour and wound exudate, and
infection, and psychosocial factors, such as
social isolation, low self-esteem, negative body
image and depression. Non-concordance with
treatment regimens cannot be addressed fully
without knowledge of the wider psychosocial
and physical factors affecting the patient.
Healthcare professionals need to provide
CONCLUSIONS
Patients afflicted with diabetes and renal
failure, who develop ulcerated or gangrenous
lower extremities, are very difficult to manage.
Crucial in their management is an accurate
assessment of the blood supply of their lower
extremities. If the circulation proves to be
adequate, or after successful revascularisation
of the calf or foot arteries, primary amputation
as initial therapy may not be the best approach.
An aggressive local approach with infection
control and foot-sparing surgery could offer
these patients the best rehabilitation potential,
especially if they are elderly, when their potential
for rehabilitation after a major amputation
by using prosthetic limbs is limited.