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It is estimated that chronic wounds cost the NHS more than £5 billion every year, but even more devastating is the impact those same wounds can have on patients. Leanne Atkin (University Huddersfield, UK), chair of the Legs Matter Campaign, speaks to iWounds News about Tracy’s story, from the damaging effects of her venous leg ulcer to a potential solution for hard-to-heal wounds.
- When did you first meet Tracy, and how did you find out about her story?
I first met Tracy over 15 years ago, and at that time she was suffering from her first venous leg ulcer. This ulcer was challenging, but eventually she did go on to heal. Unfortunately, about 10 years ago she suffered a recurrence of her ulceration and despite deep venous bypass surgery, high compression therapy, appropriate wound bed preparation and intervention to treat superficial venous incompetence, healing was slow. For many years there was little progress with her wound and she experienced frequent infections, resulting in increased pain, odour and exudate, all of which directly affected Tracy’s quality of life.
- What were the biggest challenges faced during the treatment of Tracy’s ulcer?
One of the biggest challenges I personally faced was the fact that despite high quality evidence-based care, there were a number of months and years in which very little progress was made in terms of wound improvement. This was very frustrating as I desperately wanted to help Tracy and reduce her suffering. I simply felt like I was failing her!
- In what ways did the leg ulcer affect Tracy’s day-to-day life?
When Tracy first developed her leg ulcer she was a wife, running a business and a mother of two young children. The impact this had on her life was enormous. She was taking morphine for the pain which affected her ability to drive, she could not take her children swimming, struggled to walk for any length of time, and had issues with the smell and exudate that made her increasingly anti-social: all of this had an impact on her marriage. However, it was her recollection of the wound’s impact on her self-worth and self-confidence which really brings the difficulty of living with a leg ulcer home to me as a clinician – these are Tracy’s words:
“I am upset about the life I could have had, the career I should have had and for the person that I should have been.
I always thought I would be somebody and achieve something in life but I feel like I have had that opportunity stolen away. I hate feeling self-conscious, disabled and unattractive and I hate that this leg ulcer has taken away my self-confidence.”
- Is there enough awareness of how venous leg ulcers can affect people of a younger age?
Definitely not and if you ask a clinician to identify younger patients with venous disease they will often picture morbidly obese patients or patients with a history of intravenous drug use. Tracy was neither of these: she had a pre-thrombotic tendency which resulted in deep vein thrombosis (DVT) during pregnancy, ultimately causing venous insufficiency and the start of her ulceration. Clinicians, especially nurses, tend to think of the average venous leg ulcer patient as being in their seventies, not their thirties. The effect on a patient’s quality of life is significant no matter what the age of the patient, but there is added complexity with patients of a younger age including issues with sexual relationships, parenting, working, career, ambition and their ability to exercise, all of which impact self-worth and confidence. This was one of the reasons that Tracy became part of the Legs Matter campaign: to share her story and the impact this can have on an individual, to try to ensure the appropriate assessment and treatment of sufferers of lower limb ulceration, and also to raise awareness that leg ulceration affects any age group.
- How did EpiFix help with the progression of healing for Tracy’s ulcer following the presentation at Wound Care Today?
As part of the Legs Matter awareness campaign, Tracy presented her story of living day-to-day with an active leg ulcer at the Wound Care Today conference. In the audience was a member of the company who produced EpiFix and they approached me and Tracy following her presentation, offering to support a free evaluation of their product. I must admit that I was very sceptical, as we had previously tried every wound care product with little long-term success. However, both myself and Tracy were open to new suggestions and desperate to try anything which may help. Truthfully, neither of us expected any true benefit from using this but agreed we had very little to lose!
Permission was gained from the NHS to evaluate this product for Tracy and within a few months of her presentation, the first application of EpiFix was completed. The changes in Tracy’s wound were dramatic. Within weeks, the wound bed appeared active with improved quality and amount of granulation tissue. Over time, epithelisation was evident and within 24 weeks the wound was completely healed. I believe in an evidence base and am completely aware that a single case is not a robust form of evidence, therefore I am unable to state whether it was the EpiFix which truly healed Tracy. However, there had been no progress for over 6 years, having tried every wound product on the market with very little success. Therefore, EpiFix potentially provides a real solution for chronic non-healing wounds and further investigation into this product is urgently required.