The Skin Care Service (SCS) is a team of specialist tissue viability nurses that have undergone additional training and development in tissue viability and lower limb care.  Our aim is to improve patient outcomes in Mersey Care by promoting standardised best practice in Wound Care, regardless of aetiology. Through audit, education and research, we aim to continually update knowledge base and practice built on evidence available. The Skin Service covers all adult patients registered with a Liverpool or South Sefton GP or living within the Liverpool/South Sefton Area. 

Conditions and treatment

The following resources are available to support clinicians within their practice:  

Larval therapy, also called larvae therapy, uses live larvae to selectively and precisely remove devitalised tissue from a wound. Larvae secrete proteolytic enzymes which liquefy the devitalised tissue, and the Larvae then ingest the dead tissue through the net of the Biobag dressing. Larval therapy has many benefits in the wound healing process. Larvae help a wound to progress from the inflammatory phase of healing, reduce malodour, reduce infection rates and also help to eradicate biofilm.  

NICE define a leg ulcer as a wound to the lower leg that has failed to heal within 2 weeks. There are several reasons why a leg ulcer may develop with over 70% of lower leg ulcers caused by venous insufficiency, 10% are attributed to arterial disease, 10% to 15% are mixed aetiology and 2% to 5% other causes such as connective tissue disorders, vasculitis or malignancy. It is estimated that approximately 1% of the population in the United Kingdom will suffer from leg ulceration at some point in their lives with the experience often impacting negatively on their quality of life. Without correct treatment, ulcers can remain unhealed for many months or sometimes years, resulting in episodes of infection, pain and immobility. 

MASD consists of four distinct conditions, with slightly different aetiologies, namely: incontinence-associated dermatitis; intertriginous dermatitis; peri wound moisture-associated dermatitis and peristomal moisture-associated dermatitis. MASD occurs when moisture remains in constant contact with the body for prolonged periods of time, when it contains irritating substances, bacterial or fungal pathogens, and when moisture exposure increases friction at the skin surface.  

Negative Pressure Wound Therapy (NPWT) also known as Topical Negative Pressure (TNP) or Vacuum Assisted Closure (VAC) applies either continuous or intermittent sub-atmospheric pressure to promote improved wound healing in chronic, difficult to heal wounds. It provides a closed system that protects the wound from external sources of contamination, whilst creating optimal conditions for complex wounds. NPWT is both a clinically and cost-effective treatment that can be used to provide maximum therapeutic benefits to the patient with complex needs. On the Merseycare Formulary the two NPWT systems in use are the Activac system and Avelle, and after a thorough assessment the most suitable system will be prescribed.  

A pressure ulcer is localised damage to the skin and/or underlying tissue, usually over a bony prominence (or related to a medical or other device), resulting from sustained pressure (including pressure associated with shear). The damage can present as intact skin or an open ulcer and may be painful. In 2018 it was estimated that 202,000 patients were living with an unhealed pressure ulcer, with a mean annual cost of £5900 per pressure ulcer.   

A wound is a disruption of the integrity and function of the tissues in the body. Any injury to the skin interrupts continuity and the protective and functional capacity, rendering the individual physically and emotionally vulnerable, therefore achieving wound healing is a priority. Failure to appropriately assess wounds leads to increased healing times, patient discomfort, increased risk of infection, inappropriate use of dressings and reduction in patient quality of life. Effective wound management requires an understanding of the physiology of wound healing, combined with an ongoing process of assessment, clinical decision making, intervention, and documentation to facilitate optimal wound healing. 


More information

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Patients can be referred to the SCS by their GP, community nurse or any other health care professional. Referrals should be made using the Skin Care Service Referral form and emailed to  Referrals are triaged during 9am to 10.30am and 3pm to 5pm.

The Skin Care Service offer different levels of intervention, and after careful triage by one of our specialist nurses the most appropriate level of support will be offered. 

  1. Advice given over the phone to other professionals about generic wound conditions/aetiology and wound management products but will not be patient specific. The referrer is clinically responsible for the treatment prescribed following the advice. 
  2. Patient specific advice can be given over the phone to the referrer after careful review of the patients notes and clinical photography. The referrer is clinically responsible for the treatment prescribed following the advice. 
  3. Joint visit with referrer, advice and education will be offered for the management of the patients care. Responsibility for monitoring of efficacy, adverse reactions, interpretation of investigations and the re-assessment of the patient treatment plan will remain with the referrer.