This case highlights the importance of ensuring that patients are appropriately assessed and monitored for suitability for compression stockings and that measures are taken to ensure they are worn appropriately. He was last seen in the community by the plastic surgery specialist nurses 2 months post-surgery where it was noted that all his wounds had healed and he was discharged from our care. He was transferred to his local district hospital for rehabilitation 3 weeks following admission and discharged from there with a package of care 2 weeks later. His recovery was slowed by a catheter-related urinary sepsis, however he went on to make a good recovery.
#COMPRESSION STOCKINGS FOR WOMEN SKIN#
Thirteen days post-debridement the patient underwent a skin grafting procedure. Negative pressure wound therapy was applied for 12 days until microbiology swabs were clear and sufficient healthy granulation tissue was present. The wound was not suitable for immediate skin grafting. The surgical debridement removed all non-viable tissue, including the necrotic, exposed tibialis anterior tendon ( Figure 3). Initial management included intravenous flucloxacillin and careful pre-operative assessment for a debridement under general anaesthesia. Wound swabs in the community had grown Staphylococcus aureus, however the wound was not clinically infected with no surrounding cellulitis.Įxposed necrotic tibialis anterior tendon. When the patient held his foot in a neutral position his necrotic tibialis anterior tendon was clearly visible and bow stringing out in front of his ankle ( Figure 2). The skin, subcutaneous fat and extensor retinaculum of the anterior lower leg and foot had been eroded with the wound measuring 5 × 10 cm ( Figure 1). It was noted that the stockings were rolled at the point of the ulcer, creating increased pressure in this area. When the patient presented to our unit for his initial assessment, he had the stockings applied over the wound. After 10 months of conservative treatment, with continued deterioration and no progress observed, the patient was reviewed by his GP and referred to the local plastic surgery service for further advice. However, they continued to apply the compression stockings on top of the dressings and subsequent deterioration was noted. This new ulcer was initially managed in the community by the district nursing team. The patient developed a new ulcer on the anterior aspect of his shin, proximal and lateral to the original ulcer, thought to be as a result of pressure from the compression stockings. Initially the stockings were beneficial and the ulcer resolved, however, their continual use subsequently caused problems. At that time it was noted that he was overweight and had chronic oedema of both legs and feet. He was initially referred to the vascular surgeons in 2002 with a venous ulcer on the medial aspect of his left ankle and it was recommended that he be treated conservatively with grade 3 compression stockings (40–60 mmHg). His past medical history includes type II diabetes and venous disease. The patient is an 76-year-old male who lives alone in sheltered accommodation and mobilises with the aid of a zimmer frame. Although an extreme case, it highlights the importance of careful assessment, application, and monitoring of compression stockings. Here we present the case of an older male who was referred to a local plastic surgery service for the management of a pressure sore on the anterior aspect of his left lower leg as result of compression stocking application for the treatment of venous ulcer disease. Unevenly distributed and excess pressure may break the skin, especially in older, malnourished patients and those with thin, brittle skin. Although the application of compression stockings can appear simple, it must be remembered that inappropriately worn stockings have the potential to cause significant problems. Most patients admitted to hospital are automatically at a higher risk of developing thromboembolic disease and should therefore receive appropriate prophylaxis 2. Compression stockings play an important role in the management of venous disease, venous ulcers, and preventing thromboembolic disease of the deep venous system in the legs 1.
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