INTRODUCTION: The ulcers of the lower limbs are cited as the main cutaneous manifestation of sickle-cell anemia. Infection of sickle-cell leg ulcers is often considered inevitable, but its role in the emergence and perpetuation of the injury remains controversial. This study aims to characterize the microbiota of leg ulcers in patients with sickle-cell anemia and compare it to the microbiota of ulcers of other etiologies. METHODS: This was a descriptive cross-sectional study, consisting of two groups (patients with sickle-cell leg ulcers and patients with ulcers of other etiologies), where was studied the lesion microbiota and its antimicrobial susceptibility. The material was collected with aseptic technique, by curettage of the ulcer, and was analyzed by standard and automated methods. RESULTS: Each group consisted of 19 patients, and was observed in patients with sickle-cell leg ulcer the prevalence of only one bacteria (57.9%), with 31.6% of sterile cultures, and Staphylococcus aureus (31.6 %) and Pseudomonas aeruginosa (26.3%) were the major microorganisms isolates. In the evaluation of antimicrobial resistance were observed 2 cases (40%) of P. aeruginosa resistant to aminoglycosides, 1 case (20%) to Ciprofloxacin and 3 cases (60%) to Cefepime, and 2 cases (33.3%) of S. aureus resistant to Oxacillin and 1 case (16.7%) to Linezolid. On ulcers of other etiologies were seen bacterial growth in 100% of the 19 cases, with higher microbial diversity and predominance of Gram-negative (89.5%), especially of Pseudomonas spp., Klebsiella spp. and Proteus mirabilis. The antibiogram demonstrated greater resistance, with evidence of resistance to fourth generation´s cephalosporins, carbapenems and aminoglycosides. In contrast, the lesions not related to sickle-cell disease showed more frequent bacterial isolation, higher microbial diversity and less favorable antimicrobial resistance profile. The study results suggest a weak relationship between the local flora and the evolution of sickle cell ulcers. / INTRODUÇÃO: As úlceras em membros inferiores são citadas como a principal manifestação cutânea da anemia falciforme. A infecção das úlceras falcêmicas é frequentemente considerada inevitável, porém seu papel no surgimento e perpetuação das lesões ainda permanece controverso. O presente estudo propõe caracterizar a microbiota da úlcera de membro inferior em pacientes com anemia falciforme e compará-la à microbiota de úlceras de outras etiologia. MÉTODO: Trata-se de um estudo descritivo e transversal, composto por dois grupos (pacientes com úlcera falcêmica e pacientes com úlceras de outras etiologias), sendo estudadas a microbiota lesional e sua suscetibilidade antimicrobiana. A coleta foi realizada com técnica asséptica, por curetagem, sendo o material analisado por técnica padrão e por método automatizado. RESULTADOS: Cada grupo foi composto por 19 pacientes, sendo observado nos pacientes com anemia falciforme e úlcera cutânea o predomínio de uma biota unimicrobiana (57,9%), com 31,6% das culturas estéreis, sendo o Staphylococcus aureus (31,6%) e a Pseudomonas aeruginosa (26,3%) os principais germes isolados. Na avaliação da resistência antimicrobiana, foram observados 2 casos (40%) de P. aeruginosa resistentes a aminoglicosídeos, 1 caso (20%) à Ciprofloxacina e 3 casos (60%) à Cefepima, além de 2 casos (33,3%) de S. aureus resistentes à Oxacilina e 1 caso (16,7%) à Linezolida. Por outro lado, as úlceras de etiologia não falcêmica demonstraram crescimento bacteriano em 100% dos 19 casos, com maior diversidade microbiológica, sendo isolados predominantemente Gram negativos (89,5%), principalmente Pseudomonas spp., Proteus mirabillis e Klebsiella spp.. O antibiograma do grupo demonstrou maior resistência, com evidência de resistência à cefalosporinas de quarta geração, carbapenêmicos e aminoglicosídeos. Em comparação, as lesões não falcêmicas demonstraram isolamento bacteriano mais frequente, maior diversidade microbiológica e perfil de resistência antimicrobiana menos favorável que na anemia falciforme. Os resultados do estudo sugerem uma fraca relação entre a microbiota local e o aparecimento e evolução das úlceras falcêmicas.

A úlcera de perna representa demanda crescente nos serviços de saúde. Por tratar-se de uma doença crônica, recorrente e de difícil manejo, a úlcera de perna é um problema que vem desafiando profissionais, pacientes e famílias. A necessidade de entender melhor a problemática existente no cuidado oferecido pelo enfermeiro ao paciente com úlcera e sua família, motivou a pergunta do estudo, a qual buscou responder como a família influencia e é influenciada pela úlcera de perna. O estudo teve como objetivo conhecer as percepções e crenças do paciente e de sua família em relação à úlcera de perna, bem como compreender como essas crenças influenciam o enfrentamento da família na experiência. O estudo de caso foi o método adotado, e as técnicas da história oral foram utilizadas para a coleta de dados. O estudo foi realizado com um casal idoso, o qual convive com a úlcera de perna da mulher, focando o impacto desse evento na história da família. As narrativas do casal permitiram a construção da memória coletiva organizada em três temas distintos os quais se inter-relacionam: Envelhecimento e doença, Jornada do tratamento, A ferida e o tempo. Os resultados permitiram compreender que a família influencia e é influenciada pela úlcera de perna e esta dinâmica determina um grande impacto na vida do casal que se encontra na fase tardia do ciclo de vida da família. O estudo identificou que as crenças do casal exercem grande influência sobre o impacto da doença em sua vida, além de determinar seu enfrentamento diante da situação. Este estudo, por considerar a família como categoria de análise, lança um novo olhar ao problema e acrescenta um conhecimento diferente no que se refere à relação entre a família e a ferida. Os resultados permitem uma reflexão acerca da importância do conhecimento profundo dos enfermeiros sobre as experiências dos pacientes e famílias que convivem com úlceras de perna. A valorização e o reconhecimento das forças da família no enfrentamento da doença e da mudança de comportamento do enfermeiro na prática clínica, a qual deve integrar um olhar além da ferida, considerando a interface entre a doença e o contexto familiar, são elementos capazes de estimular uma prática clínica centrada na família. / A leg ulcer is increasing demand on health services. Because it is chronic, recurrent and difficult to handle, leg ulcer is a problem that has defied professionals, patients and families. The need to better understand the problems existing in the care offered by nurses to patients with ulcer and their families led to the question of the study, which sought to answer how the family influences and is influenced by leg ulcer. The study aimed to understand the perceptions and beliefs of the patient and the family regarding leg ulcer as well as understand how these beliefs influence family coping experience. The case study method was adopted, and the techniques of oral history were used for data collection. The study was conducted with an elderly couple, who lives with woman\'s leg ulcer, focusing on the impact of this event in the family history. The narratives of the couple allowed the construction of collective memory organized into three distinct themes which are interrelated: Aging and illness, Journey of treatment, Wound and time. The results allowed to understand that family influences and is influenced by leg ulcers; family dynamics determines a great impact on the couples lives experiencing the late stage of the family life cycle. The study identified that the couples beliefs have great influence on the impact of the disease on their lives, and determine how they cope with the situation. This study, seeing the family as category of analysis, proposes a new perspective at the problem and adds new knowledge to the interaction between family and wound. The results allow a discussion about the importance of deep nursing knowledge about the experiences of patients and families living with leg ulcers. This new perspective requires a change in behavior of the nurse in clinical practice for a vision beyond the wound. The appreciation and recognition of the strengths of the family in coping with the illness and considering the interface between the disease and the family context are elements capable of stimulating a nursing family-centered practice.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The ulcers of the lower limbs are cited as the main cutaneous manifestation of sickle cell anemia, presenting a chronic course, with pain and many complications. Treatment of sickle ulcers is complex, involving care wound bed, management of anemia, pain management and treatment of opportunistic infections, among the various proposed treatments highlight the use of covers with inelastic bandage impregnated with zinc, the boot Unna. However there are still no controlled trials to prove the efficacy of treatment. Objective: Compare treatment with conventional dressing to the use of Unna boot in patients with sickle cell anemia and ulcers in the limbs. Methodology: This is a randomized clinical trial, which analyzed patients with sickle cell ulcers that took the Unna boot , comparing them with patients with sickle cell ulcers who used the conventional dressing . Treatments were performed in a period of six weeks. Statistically analyzed the areas of lesions in three periods: at baseline (D0) in the third week (D3) and the sixth week (D6). Results: Participated in this study 19 patients with a mean age of 35.9 years (95% CI 29.1 to 42.8), 53% (10/19) were male. In these individuals was analyzed the healing of ulcers in 40 lower limbs of people with sickle cell anemia 57% (23/40) in the experimental group and 43% (17/40) in the control group. There was a mean variation in lesion area when used Unna boot of 20.2 cm2 at T0 time, 17.9 cm2 in time T3 and 6.2 cm2 in time T6 (P < 0.001), mean percentage of total reduction of 77 1%, obtained by Tarajad index, when used as a simple dressing ranged from 31.3 cm2 35.8 cm2 33.9 cm2 at times T0, T3 and T6, respectively (P <0.001) and an average percentage of 22.8 %. Conclusion: The results suggest that the use compression therapy with Unna boot is an effective treatment of lower limb ulcers in patients with sickle cell anemia, aimed at reducing ulcer area, improvement of the injury aspect and pain alleviation. / As úlceras em membros inferiores são citadas como a principal manifestação cutânea da anemia falciforme, apresentando um curso crônico, com dor e muitas complicações. O tratamento das úlceras falcêmicas é complexo, envolvendo cuidados com o leito da lesão, manejo da anemia, controle da dor e tratamento de infecções oportunistas, dentre os diversos tratamentos propostos destaca-se o uso de coberturas com bandagem inelástica impregnada com zinco, a bota de Unna. No entanto ainda não existem ensaios clínicos que comprovem a eficácia do tratamento. Objetivo: Comparar o tratamento com curativo convencional à utilização de bota de Unna em pacientes com anemia falciforme e úlceras em membros inferiores. Método: Trata-se de um ensaio clínico randomizado, onde foram analisados pacientes com úlcera falcêmica que fizeram uso da bota de Unna, comparando-os com pacientes com úlceras falcêmicas que fizeram uso do curativo convencional. Os tratamentos foram realizados em um período de seis semanas. Foram analisadas estatisticamente as áreas das lesões em três períodos: no momento inicial (D0), na terceira semana (D3) e na sexta semana (D6). Resultados: Participaram dessa pesquisa 19 pacientes com idade média de 35,9 anos (IC95% = 29,1 a 42,8), sendo 53% (10/19) do sexo masculino. Nesses indivíduos foi analisada a cicatrização de 40 úlceras em membros inferiores de pessoas com diagnóstico de anemia falciforme sendo 57% (23/40) no grupo experimental e 43% (17/40) no grupo controle. Houve uma variação média da área lesional quando utilizado bota de Unna de 20,2 cm2 no tempo T0, 17,9 cm2 no tempo T3 e 6,2 cm2 no tempo T6 (P<0,001), com média percentual de redução total de 77,1%, obtido através do índice de Tarajad, enquanto quando se usou o curativo simples teve uma variação de 31,3 cm2, 35,8 cm2, 33,9 cm2, nos tempos T0, T3 e T6 respectivamente (P<0,001), e um percentual médio de 22,8%. Conclusão Os resultados sugerem que a utilização da terapia compressiva com bota de Unna constitui um tratamento efetivo das úlceras de membros inferiores em pacientes portadores de anemia falciforme, atuando na redução da área da úlcera e na melhora do aspecto lesional.

Bakgrund  Venösa bensår är vanligaste typen av bensår och orsakas i de flesta fall av en nedsatt cirkulation i nedre extremitet, venös insufficiens. De venösa bensåren är oftast svårläkta med lång duration och har hög återfallsrisk. En åldrande kropp ger risk för lång läkningsprocess. Då venösa bensår är vanligast hos den äldre befolkningen och i takt med en åldrande befolkning förväntas problemen med venösa bensår öka. Att belysa hur de äldre personerna upplever att leva med venösa bensår, borde även vara av intresse för sjukvårdspersonal som troligtvis kommer möta dessa personer. Detta kan bidra till en helhetssyn där personen och upplevelsen sätts i fokus. Syfte Syftet var att belysa den äldre personens upplevelse av att leva med venösa bensår. Metod För att besvara syftet valdes en icke-systematisk litteraturöversikt som metod. I denna litteraturöversikt har 15 artiklar inhämtats från databaserna CINAHL och PubMed. Artiklarna analyserades med en integrerad analys och kvalitetsgranskades med Sophiahemmets högskolas bedömningsunderlag.  Resultat  De venösa bensåren bidrog till att många äldre drar sig undan från sociala sammanhang på grund av skam, smärta och immobilitet. Självkänslan påverkas då många upplevde en penibel känsla när såren luktande och vätskade igenom. Förbanden doldes i många fall med långa kläder och det var svårt att hitta skor som passade de lindande fötterna. Smärta och rädsla försvårade de äldre personernas möjlighet till fysisk aktivitet.  Slutsats Sammanfattningsvis visar denna litteraturöversikt att många äldre personer med venösa bensår upplever att livet begränsats ur ett socialt, emotionellt och fysiskt perspektiv. Många äldre personer med venösa bensår upplever otillräcklig kommunikation med sjuksköterskan. Många upplevde bristande förtroende för sjuksköterskan på grund av inkonsekventa och utdragna behandlingar som inte gav resultat. Det saknas ny och relevant forskning gällande de äldre personernas upplevelse av att leva med venösa bensår och mer forskning behövs för att optimera upplevelsen och öka välbefinnandet. / Background Venous leg ulcers are the most common type of leg ulcer and are caused in most cases by a reduced circulation in the lower extremity, venous insufficiency. The venous leg ulcers usually have a difficulty to heal with a long duration and have a high risk of recurrence. An aging body carries the risk of a long healing process. As venous leg ulcers are most common in the older population and in step with an aging population, the problems with venous leg ulcers are expected to increase. To highlight how older people experience living with venous leg ulcers, it should also be of interest to healthcare professionals who are likely to meet these people. This can contribute to a holistic view where the person and the experience are put in focus. Aim The aim was to highlight the older persons’ experience living with venous leg ulcers. Method To answer the purpose of this study, a non-systematic literature review was undertaken. This study has included 15 articles collected from the databases CINAHL and PubMed. The articles were analysed with an integrated method and Quality controlled with Sophiahemmet University’s assessment basis. Results Many older persons experienced that venous leg ulcers contributed to withdrawing from social contexts due to shame, pain, and immobility. Self-esteem was affected when many experienced an unpleasant feeling when the ulcers smelled and exuded. The bandages were often hidden with long clothes and there were difficulties to find fitting shoes to fit the wrapped feet. Pain and fear complicated the older persons ability to participate in physical activities. Conclusions In conclusion, this literature review shows that many older persons with venous leg ulcers experience that their life has been limited from a social, emotional, and physical perspective. Many older people with venous leg ulcers experience insufficient communication with the nurse. Many experienced a lack of trust in the nurse due to inconsistent and protracted treatments that did not yield results. There is a lack of new and relevant research regarding the older persons experience of living with venous leg ulcers and more research is needed to optimize the experience and increase well-being.

Bakgrund: Vid omvårdnad av personer med bensår är det lätt att lägga fokus på bensåret med risk för att den subjektiva upplevelsen kan komma i skymundan. Därför kan det vara viktigt att belysa patienters upplevelser ur ett holistiskt perspektiv. I tidigare forskning har det framkommit att livskvaliteten påverkas negativt där smärta visat sig vara en betydelsefull faktor. Syfte: Att ur ett livskvalitetsperspektiv belysa personers upplevelse av att leva med svårläkt bensår. Metod: En litteraturöversikt baserad på 10 vetenskapliga artiklar med kvalitativ ansats. En deduktiv analys av materialet gjordes utifrån World Health Organisations definition av livskvalitet och dess sex domäner. Dessa domäner är: Fysisk domän, Psykologisk domän, Grad av oberoende, Sociala relationer, Omgivning och miljö samt Andlighet, religion och personlig tro. Resultat: Svårläkta bensår påverkade personers livskvalitet inom samtliga domänerna utom Andlighet, religion och personlig tro. Slutsats: Personer hade liknande upplevelser av att leva med svårläkta bensår. De upplevde en försämrad livskvalitet där smärtan var en framträdande upplevelse som påverkade de flesta domänerna. Klinisk betydelse: Resultatet i denna studie visade på vikten av att använda ett holistiskt perspektiv vid omvårdnadssituationer. / Background: When caring for people with chronic leg ulcer there is a risk that the attention of the caregiver is laid towards the leg ulcer and the subjective feelings of this person are in the background. Therefore it is of importance to illuminate peoples experience with a holistic perspective. Previous research in the field has shown that the quality of life is affected in a negative way and the pain has proven to be a significant factor. Purpose: To illuminate person‟s experience of living with a chronic leg ulcer from a quality of life perspective. Method: A review based on 10 articles with qualitative approach. The material was analyzed with a deductive method from the World Health Organization. These domains are: physical domain, psychological domain, level of independence, social relationships, environment and spirituality/religion/personal beliefs. Results: Study findings showed that chronic leg ulcers affected quality of life in all domains except within the domain Spirituality, religion and personal beliefs Conclusion: People had similar experience when living with a chronic leg ulcer. They experience a loss in quality of life due to the chronic leg ulcer and pain was a notable finding that affected almost every domain. Clinical importance: The finding in this study shows the importance of using a holistic perspective in caring-situation.

Tropical ulcer is a very specific form of cutaneous ulceration. It occurs worldwide in most tropical and a number of subtropical areas. The disease occurs mainly in older children and young adults with children under the age of 5 and adults over 45 years rarely being affected. Ulcers occur most commonly on the lower leg but may occur on the upper limb. Although most ulcers normally heal slowly over many weeks or months, some ulcers may recur. Recognised complications include squamous cell carcinoma, gangrene and osteitis, although these are rare. A number of authors have reported on the disease and suggested diet, trauma and infection as aetiological factors for this condition. This survey was thus conducted to assess as many of these factors as possible. The study took place in 5 tropical areas, namely Zambia, Gambia, southern India, Fiji and Papua New Guinea. Consultations took place at hospitals, rural clinics, health centres and villages. Although many authors have suggested that the disease is related to malnutrition, few have objectively assessed the nutritional status of the patients and compared it with controls. Those studies which included objective assessments were limited to small areas and only investigated specific parameters. In order to investigate the immune response of the host to an anaerobic infection, the antibody levels to the organisms isolated from the ulcers were measured by an ELISA test. The local host response to an infection with a Fusobacterium species was assessed by the number of antibody secreting B-lymphocytes at the site of the ulcers. These parameters may play a role in the localisation of the ulcers and account for recurrent infections.

No description available.

Bakgrund: Sår på nedre extremiteter är vanligt förekommande, särskilt hos äldre. De sår som inte läkt inom sex veckor räknas som svårläkta och brukar medföra stora lidanden för de drabbade samt stora samhällsekonomiska kostnader. Sårens komplexitet påverkas av bakomliggande sjukdomsfaktorer och diabetespatienter är särskilt utsatta. Kosten är grundläggande för att upprätthålla kroppens livsviktiga funktioner men trots detta används sällan nutritionsbehandling för denna typ av sår. Syfte: Att sammanställa nutritionens betydelse för sår på nedre extremiteter. Metod: En litteraturstudie baserad på 15 kvantitativa empiriska studier om nutritionens betydelse för bensår och/eller diabetiska fotsår. Huvudresultat: Samband identifierades mellan nutritionsstatus och såromfattning där sämre nutritionsstatus ledde till mer allvarliga sår och ökad amputationsrisk. Näringsbrister, framför allt av mikronäringsämnena vitamin C, D, magnesium och zink, uppdagades hos deltagarna. Deltagarnas kost bestod av hög andel kolhydrater och fett medan proteinintaget i många fall var under rekommenderade nivåer. Trots påtaglig undernäring led majoriteten av deltagarna av övervikt eller fetma. Näringstillskott, särskilt av mikronäringsämnen, påskyndade sårläkningsprocessen och gav även förbättrade värden för CRP och glykemisk kontroll. Vikten av vitamin D är speciellt framträdande. Slutsats: Nutritionen har bevisligen stor betydelse för sårutvecklingen. Därför bör patienter med svårläkta sår utredas för eventuella näringsbrister oavsett kroppsvikt. Med individanpassade kostråd och nutritionsinsatser kan patienten bättre stödjas i strävan efter sårläkning genom egenvårdsinsatser. / Background: Ulcers on lower extremities are common, especially among the elderly. Ulcers not healing in six weeks are considered chronic and lead to significant suffering for those affected and substantial socioeconomic costs. Underlying medical factors contribute to ulcer complexity and patients with diabetes are particularly exposed. Nutrition is essential for maintaining and strengthening the body's vital functions. However, nutritional therapy is not as commonly used for lower extremity ulcers as for other wounds. Objective: To compile the significance of nutrition for lower extremity ulcers. Method: A literature review based on 15 quantitative primary studies on the significance of nutrition for leg ulcers and/or diabetic foot ulcers. Main Results: Relationship between nutritional status and ulcer size was identified where poorer nutritional status led to more severe ulcers and increased risk of amputation. Nutritional deficiencies, especially micronutrients vitamin C, D, magnesium, and zinc, were found among the participants. Diets consisted of a high proportion of carbohydrates and fats, while protein intake often was below recommended levels. Most participants were overweight or obese despite apparent malnutrition. Nutritional supplements, especially of micronutrients, accelerated the ulcer healing process and improved values for C-reactive protein (CRP) and glycemic control in controlled studies. The importance of vitamin D was emphasized in this literature review. Conclusion: Nutrition plays a significant role on ulcer development. Patients with chronic ulcers should be screened for potential nutritional deficiencies, regardless of body weight. With individualized dietary advice and nutritional interventions can patients receive better support in efforts for self-care and ulcer healing.

Bakgrund: Kroniska venösa bensår är en vävnadsskada i form av svårläkta hudsår som är lokaliserade nedanför knäleden och är orsakade av försämrat blodflöde i venerna. Trots att många människor drabbas av återkommande, smärtsamma och resurskrävande sår är de en medicinskt lågprioriterad grupp. Syfte: Syftet var att beskriva hur det är att leva med venösa bensår. Metod: En litteraturöversikt baserat på tio vetenskapliga originalartiklar. För artikelsökningen använde vi oss av databaserna Cinahl Complete och PubMed. Analysen utfördes inspirerad av Fribergs metod. Resultat: Analysen av artiklarna ledde till tre temaområden: somatiska besvär, psykosocialt lidande och omgivningens förhållningssätt Slutsats: Personer med bensår upplever betydande fysiskt och emotionellt lidande, inklusive smärta, skamkänslor och social isolering. Dessa patienter är beroende av vårdpersonal och anhöriga, och behöver en holistisk vård med fokus på både såret och den mänskliga aspekten. Ytterligare forskning behövs särskilt kring relationen mellan bensårspatienter och deras närmaste familj. / Background Chronic venous leg ulcers are tissue injuries in the form of hard-to-heal skin sores located below the knee, caused by impaired blood flow in the veins. Despite affecting many individuals with recurrent, painful, and resource-intensive sores, they are a medically low-priority group. Aim The aim was to describe what it is like to live with venous leg ulcers. Method A literature review based on ten scientific articles. The databases Cinahl Complete and PubMed was used in search for the articles. The article analysis was based on Friberg's analysis model. Results The analysis of the articles resulted in three thematic areas: somatic symptoms, psychosocial suffering, and the attitudes of the surroundings. Conclusions Individuals with leg ulcers experience significant physical and emotional suffering, including pain, feelings of shame, and social isolation. These patients depend on healthcare professionals and relatives, requiring holistic care that addresses both the wound and the human aspect. Further research is particularly needed regarding the relationship between leg ulcer patients and their immediate family.

Bakgrund: Svårläkta bensår anses idag som ett växande folkhälsoproblem. Det drabbar framför allt personer över 65 år och medför ofta smärta och försämrad livskvalitet eftersom de ofta tar lång tid att läka. Prevention och behandling av dessa sår kräver stora sjukvårdsresurser. Distriktssköterskan/sjuksköterskan inom primärvården behandlar en betydande del av svårläkta bensår. Syfte: Syftet med studien var att beskriva distriktssköterskan/sjuksköterskans erfarenheter att bedöma svårläkta bensår. Metod: Studien har en kvalitativ induktiv ansats. Fjorton distriktssköterskor/sjuksköterskor i sydöstra Skåne har intervjuats individuellt. Under intervjun har en semistrukturerad intervjuguide använts. Intervjuerna har analyserats med kvalitativ innehållsanalys. Resultat: Distriktssköterskorna/sjuksköterskorna erfor att de hade tillräcklig kunskap att bedöma svårläkta bensår, och att de hade förmågan att omsätta kunskaperna praktiskt. De använde sig inte av några riktlinjer vid bedömningen utan menade att deras erfarenhet styrde bedömningen och vilka åtgärder som skulle vidtas. De menade att det var betydelsefullt att försöka se patienten ur ett holistiskt perspektiv och att det var en fördel om man hade ett engagemang för bensår då det ofta vara frågan om långvariga tålamodsprövande behandlingar. Distriktssköterskan/sjuksköterskan använde sig i olika omfattning av andras kompetens. Det var en självklarhet att man tillfrågade andra när man var i behov av råd eller hjälp. Slutsats: Bensårssjukdomar utgör en betydande volym inom primärvården och distriktssköterskan behöver rätt förutsättningar för att kunna bedöma dessa. Implementering av riktlinjer och bedömningsmallar skulle vara ett sätt att tillmötesgå detta behov. Det finns även ett behov av att utveckla samarbetet mellan berörda professioner som behandlar patienter med svårläkta bensår. Att ge distriktssköterskan de rätta förutsättningarna att omhänderta svårläkta bensår skulle innebära att hon kan arbeta efter evidensbaserade riktlinjer och dessutom få möjlighet till utveckling inom området. / Background: Chronic leg ulcers are today considered as a growing public health problem. This affects mainly people over 65 years and often results in pain and impaired quality of life because they often take a long time to heal. Prevention and treatment of these wounds require large health-care resources. The district nurse/nurse in primary health care addresses a significant portion of chronic leg ulcers. Aim: The aim of the study was to describe the district nurse/nurse's experiences to assess chronic leg ulcers. Method: A qualitative inductive approach was used. Fourteen district nurses/nurses in Southeast Skåne were interviewed individually. During the interview a semi-structured interview-guide was used. The interviews was analyzed using qualitative content analysis. Results: District nurses/nurses felt that they had sufficient knowledge to assess chronic leg ulcers, and that they had the ability to translate knowledge into practice. They used no guidelines in the assessment but felt that their experience ruled the assessment and  measures to be taken. They said it was important to see the patient from a holistic perspective and that it was an advantage to have a commitment for leg ulcers because treatments are often demaning and extended over a long time. The district nurse used in varying degrees other people's skills. For them it was obvious necessity for them to consult others when they were in need of advice or help. Conclusion: Chronic leg ulcers represent a significant volume of primary care, and the district nurse needs the right conditions to be able to assess these. Implementation of the guidelines and scoring protocols would be a way to go to meet this need. There is also a need to develop cooperation between the concerned professions who treat patients with chronic leg ulcers. To give the district nurse the right conditions to dispose of chronic leg ulcers mean that she can work on guidelines and opportunities for development and training on evidence-based level.