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Knowledge of the correct levels of tissue fluid is vital to ensure a smooth healing process. Leanne Cook and Clare Barker offer advice on selecting appropriate dressings for residents

The incidence and prevalence of lymphoedema and chronic oedema is increasing as a result of the aging population and increased obesity rates. Oedema is frequently recognised but not promptly treated ( Hedger, 2006 ). Practitioners must remember that oedema is a symptom and the cause needs to be established to ensure that appropriate treatment can be initiated. Successful management of chronic oedema involves a continuing partnership between the patient and practitioner to promote self-management. This article describes the progression of chronic oedema and subsequent skin changes, and highlights some of the challenges faced by the practitioner in facilitating effective care.

Wound infection delays healing and impairs quality of life. Leanne Cook and Karen Ousey discuss the recognition and treatment of wound infections, which are essential skills for practice nurses

It is important to undertake a holistic assessment of the patient who presents with a wound. Karen Ousey and Leanne Cook give an overview of the key responsibilities of the practice nurse

Management and treatment of wounds is costly to health care. As such, accurate wound assessment is an essential skill required to enhance the wound healing process. Wound assessment tools are available to assist practitioners to ensure that wounds are correctly assessed, healing is documented, and factors that could delay healing are identified and appropriately managed. In an attempt to understand current practices a survey was undertaken of delegates attending the Wound Expo 2011 wound assessment zone to provide a clearer insight into today’s practises and opinions relating to wound assessment. The results were collated and are presented in this article.

Wound infection delays healing and impairs quality of life. Leanne Cook and Karen Ousey discuss the recognition and treatment of wound infections, which are essential skills for practice nurses

Venous leg ulcers can be highly exuding and moisture management is often challenging. The emergence of super-absorbent dressings have been marketed as a tool to manage high levels of exudate, in combination with compression therapy, for the management of venous leg ulcers. Compression bandages are designed to give precise amounts of compression which is calculated by considering the circumference of the limb. Super-absorbent dressings contain a form of polymer that swells as it locks in moisture. This study was designed to evaluate the effects of super-absorbent dressings on sub-bandage pressure. A series of controlled tests were performed using four different super-absorbent dressings which were applied to a volunteer's limb beneath compression bandaging. Sub-bandage pressures were recorded as fluid was introduced to the super-absorbent dressing. The results identified that sub-bandage pressure increases and the pressure profile changes following the expansion of the super-absorbent dressing. Further research needs to be performed to assess whether the use of these super-absorbent dressings under compression could be detrimental to venous ulcer healing.

It is important to undertake a holistic assessment of the patient who presents with a wound. Karen Ousey and Leanne Cook give an overview of the key responsibilities.

Right from the start of my nursing career, even as a student nurse, I was mystified by the question ‘what dressing should I put on that wound?’ and even more mystified by my qualified colleagues’ decision-making processes and the inconsistency that often came with this. This fuelled the desire to be able to answer the question for myself. Once qualified, I worked on a general surgery ward, which included patients undergoing vascular surgery. This is where I was exposed to extensive ulceration and looking back quite disfiguring forms of foot debridement which would be unacceptable in today’s world. This gave me the opportunity to put the little theory of wound healing and the limited knowledge of dressing actions I had into practice. Looking back I now realise I knew very little but worryingly was seen as one of the more knowledgeable in terms of wound care on the ward. In the 1990s vascular surgery started to separate into its own speciality and with it came huge advances in the options for re-vascularization. This came around the same time that the choices of wound care products were expanding; compression therapy became standard treatment for venous ulceration and my desire for knowledge grew and grew. I then had the unique opportunity to set up an out-patient vascular wound clinic while still being a ward sister, this slowly grew into a full time job and I was appointed as vascular nurse specialist in 2005. The learning curve continues to this day and I have just completed a Masters in Advancing Practice and I have recently been appointed as a part-time lecturer practitioner at Huddersfield University focusing on wound healing and peripheral vascular disease.