The Difficult Venous Ulcer: Case Series of 177 Ulcers Referred for Vascular Surgical Opinion following Failure of Conservative Management

Neequaye, Simon; Douglas, Alexander D.; Hofman, D.; Wolz, Michael; Sharma, Reena; Cummings, Roland; Hands, Linda

doi:10.1177/0003319709332901

Cited by 4 publications

(6 citation statements)

References 11 publications

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“…To help explore any differences based on country of origin we have presented results according to world geographical area and grouped by patient characteristic in Tables 2-5. Neequaye S [11] 2009 UK Multi 78 (median) 152…”

Section: Included Study Characteristicsmentioning

confidence: 99%

“…Venous incompetence was assessed using Duplex scanning in 152 patients enrolled in a EU region study of whom 8% had a normal duplex, 53% had isolated superficial incompetence, 11% had limited deep incompetence (with or without superficial incompetence) and 28% had total deep incompetence [11]. Another EU region study found reflux in isolated superficial: great saphenous vein (GSV) reflux in 34%, small saphenous vein (SSV) in 15%, GSV and SSV in 8%, perforators only 6% while reflux was reported in isolated deep as deep and GSV 16%, 11) 43 ( 28)…”

Section: Venous Incompetencementioning

confidence: 99%

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The profile of patients with venous leg ulcers: A systematic review and global perspective

Gethin

Vellinga

Tawfick

et al. 2021

Journal of Tissue Viability

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BackgroundA holistic profile that includes demographic, medical history and wound characteristics of individuals with venous leg ulceration is lacking. Lack of such a profile negatively impacts the ability to develop interventions to improve patient outcomes.Objectives: To describe the profile of the patient population with venous leg ulceration from published observational (non-interventional) studies and to identify gaps in the knowledge base for future research in this area.Methods: A systematic review of observational studies that included more than 50 patients, from any world region, of any age and in any care setting.Results: twenty studies, involving 3,395 patients, from all world regions met our criteria. Demographic characteristics were well reported and showed a female to male ratio of 1.2:1, average age of 47-65 years, high levels of co-morbidities including hypertension (53 -71%) and diabetes (16 -20%), and only one study reporting ethnicity. When reported, approximately 4-30% had high levels of depression. The average wound size was 18.6 -43.39cm 2 ; mean wound duration was 13.8 -65.5 months, mean number of recurrences was four. No study reported on demographic factors plus medical history plus wound characteristics together.Conclusion: a comprehensive, holistic profile of the population with VLU is lacking. There is a critical need for more comprehensive profiling to enable the development of targeted interventions to improve outcomes.

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Section: Included Study Characteristicsmentioning

confidence: 99%

Section: Venous Incompetencementioning

confidence: 99%

The profile of patients with venous leg ulcers: A systematic review and global perspective

Gethin

Vellinga

Tawfick

et al. 2021

Journal of Tissue Viability

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“…Nevertheless, a previous history of superficial venous surgery was associated with delayed healing [10], thus the role for venous surgery in improving healing rates of VLUs remains uncertain. Longstanding VLUs (a verified risk factor of poor healing) were more prevalent in patients with history of lower limb DVT and deep venous reflux [28]. The presence of lipodermatosclerosis, a sign of serious venous pathology, led to reduction of healing rates [10,19,26].…”

Section: Healing Of Venous Leg Ulcers -Prognostic Factorsmentioning

confidence: 99%

“…Conversely, coexisting non-venous vascular pathologies contributed to delayed healing. Ulcers of mixed arterio-venous aetiology [10,11,19,28,29] and those presenting with clinically relevant lymphedema [30] were less likely to heal. Also, a pathological functioning of the muscle pump resulted in decreased healing rates.…”

Section: Healing Of Venous Leg Ulcers -Prognostic Factorsmentioning

confidence: 99%

Prognostic factors for delayed healing of venous leg ulcers

Simka¹

2014

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Risk factors of poor healing of venous leg ulcers can be categorised into three main groups: those related to the ulcer, those related to the patient, and those related to the organisation of wound care. Identification of risk factors that predispose these patients to prolonged wound healing not only offers an opportunity to determine their clinical outcome, but can also be linked to the decision regarding alternative interventions or even reorganisation of the wound care. Factors related to the ulcer comprise large ulcer size and long ulcer duration. Also, some macroscopic features of venous leg ulcers are associated with delayed healing: fibrin covering more than 50% of the area of the wound and highly exuding ulcers. Coexisting non-venous vascular pathologies, such as arterial ischaemia or clinically relevant lymphedema, as well as history of deep vein thrombosis, can contribute to delayed healing. Additionally, pathological functioning of calf muscle pump can be associated with reduced healing. Some bacterium species seem to interfere with healing of venous leg ulcers, especially if the number of such microorganisms in the wound bed is high. Regarding patient characteristics, reduced mobility (patients being chair or bedbound) is a risk factor, while it remains unclear whether the demographic characteristics of the patients or their non-vascular co-morbidities are really associated with impaired healing. In addition, a number of studies have shown that organisation of wound care of venous leg ulcer patients appeared to be important, and healing rates improved and the cost of care declined after the implementation of an evidence-based service.

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“…Once occurred, healing rates may be as slow as 22% at 12 weeks, and recurrence rates may be as high as 69% in 12 months because of inappropriate conditions of the wound bed (17,18). Treatment of venous ulcers should start with efforts to decrease venous hypertension and regulate venous flow such as extremity elevation, compression bandaging, Unna boot application and vascular surgical intervention (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). Various techniques, wound dressing products, devices, cultured cells and growth factors have been proposed to improve healing and decrease the recurrence of venous ulcers (3,19,20,(30)(31)(32)(33)(34)(35)(36)(37)(38).…”

Section: Key Pointsmentioning

confidence: 99%

Effective use of negative pressure wound therapy provides quick wound‐bed preparation and complete graft take in the management of chronic venous ulcers

Egemen

Özkaya

Öztürk

et al. 2011

International Wound Journal

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Venous ulcers are characterised by longstanding and recurrent loss of skin integrity. Once occurred, healing is slow and recurrence is high because of inappropriate conditions of the wound bed. This study involves 20 patients with chronic venous ulcers at least 6 weeks of duration treated with negative pressure wound therapy (NPWT). Patients underwent a radical debridement of all devitalised tissues in the first operation. After adequate haemostasis, silver-impregnated polyurethane foam was applied. Once the wounds were determined to be clean and adequate granulation tissue formation was achieved, split-thickness skin grafts were applied. Black polyurethane foam was applied over them. All wounds completely healed without the need for further debridement or regrafting. The mean number of silver-impregnated foam dressing changes prior to grafting was 2·9 (one to eight changes). The mean number of NPWT foam changes was 2·6 after skin grafting (two to five changes). Two patients who did not use conservative treatments for chronic venous insufficiency (CVI) after discharge from the hospital had recurrence of venous ulcers in the follow-up period. Application of NPWT provides quick wound-bed preparation and complete graft take in venous ulcer treatment.

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The Difficult Venous Ulcer: Case Series of 177 Ulcers Referred for Vascular Surgical Opinion following Failure of Conservative Management

Cited by 4 publications

References 11 publications

The profile of patients with venous leg ulcers: A systematic review and global perspective

The profile of patients with venous leg ulcers: A systematic review and global perspective

Prognostic factors for delayed healing of venous leg ulcers

Effective use of negative pressure wound therapy provides quick wound‐bed preparation and complete graft take in the management of chronic venous ulcers

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