Risk Factors Associated With the Failure of a Venous Leg Ulcer to Heal

Abstract

Background: Venous leg ulcers afflict a significant portion of the population. The most popular form of therapy for venous leg ulcers is a compression bandage (eg, Unna boot), a therapy that is frequently unsuccessful.Objective: To describe risk factors associated with the failure of a wound to heal when treated with a limbcompression bandage for 24 weeks.Design: A retrospective cohort study.Setting: Single-center outpatient specialty clinic at an academic medical center.Participants: Two hundred sixty consecutive patients with chronic venous leg ulcers. Main Outcome Measure:The magnitude of the effect of a given risk factor on the probability that a wound will heal within 24 weeks of care.Results: Based on an assessment of leg wounds during initial office visits, we observed that the failure of a wound to heal within 24 weeks was significantly associated with larger wound area, measured in square centimeters (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.11-1.27), duration of the wound in months (OR, 1.09; 95% CI, 1.04-1.16), history of venous ligation or venous stripping (OR, 4.58; 95% CI, 1.84-11.36), history of hip or knee replacement surgery (OR, 3.52; 95% CI, 1.12-11.08), ankle brachial index of less than 0.80 (OR, 3.52; 95% CI, 1.12-11.08), and the presence of fibrin on more than 50% of the wound surface (OR, 3.42; 95% CI,.Conclusions: Several risk factors are associated with the failure of a patient's venous leg ulcer to heal while using limb-compression therapy. It is prudent to consider these factors when referring a patient to a wound care subspecialists or for alternative therapies.

VenUS I: a randomised controlled trial of two types of bandage for treating venous leg ulcers

“…8 They then proceeded to develop a prediction rule from a cohort of 260 patients treated with compression and validated it in an independent cohort of 219 patients. This simple rule (1 point if ulcer duration >6 months; 1 point if baseline area >5 cm 2 ; score of 0 predicted healing; score of 2 predicted failure to heal) discriminated between ulcers healed or not healed at 24 weeks in 87% of cases.…”

“…If a larger number of really large ulcers, say >100 cm 2 , was recruited into one trial arm, then the unadjusted analysis would not take this into account and therefore may be biased against the treatment arm containing the very large ulcers. The following variables were considered as potential covariates (prognostic factors for ulcer healing) for the Cox proportional hazards model: [8][9][10]47,70 G number of episodes of ulceration G duration of current ulcers in months G total area of ulceration at baseline…”

Avaliação da circulação arterial pela medida do índice tornozelo/braço em doentes de úlcera venosa crônica

“…1 The three main types of ulcers in the lower limbs include venous ulcers, arterial ulcers and neuropathic ulcers. 2 Venous ulcers are the most common type and represent 80% of ulcers in lower limbs with an overall prevalence ranging between 0.06 and 3.6%.…”

Can Venous Ulcer Size be Associated with the Healing Potential of Serum? Pilot Study

“…A more recent work with comparable ulcer sizes [34], corroborates that the area is associated with non-healing. Moreover in Margolis´ work (1999, [40]), the effect of wound duration on non-healing depends on wound area and vice versa. Margolis concludes that "the risk of not healing initially increases rapidly for patients with large and old wounds, but the magnitude of the increased risk diminishes with the largest and oldest wounds".…”