Venous leg ulcers: a prognostic index to predict time to healing (original) (raw)
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Risk factors for delayed healing in venous leg ulcers: a review of the literature
International journal of clinical practice, 2015
Chronic leg ulcers, remaining unhealed after 4-6 weeks, affect 1-3% of the population, with treatment costly and health service resource intensive. Venous disease contributes to approximately 70% of all chronic leg ulcers and these ulcers are often associated with pain, reduced mobility and a decreased quality of life. Despite evidence-based care, 30% of these ulcers are unlikely to heal within a 24-week period and therefore the recognition and identification of risk factors for delayed healing of venous leg ulcers would be beneficial. To review the available evidence on risk factors for delayed healing of venous leg ulcers. A review of the literature in regard to risk factors for delayed healing in venous leg ulcers was conducted from January 2000 to December 2013. Evidence was sourced through searches of relevant databases and websites for resources addressing risk factors for delayed healing in venous leg ulcers specifically. Twenty-seven studies, of mostly low-level evidence (Le...
The Ulcerated Leg Severity Assessment score for prediction of venous leg ulcer healing
British Journal of Surgery, 2007
Background The aim of the study was to create a reliable scoring system for the prediction of venous ulcer healing in patients treated with compression. Methods A prospective baseline study to identify risk factors for venous ulcer healing was undertaken between March 1999 and August 2001. All patients were treated with multilayer compression. A number of variables were related to 24-week healing rates. A Cox regression model was used to identify risk factors that predicted ulcer healing, from which a scoring system was developed and validated prospectively between February 2004 and March 2005. Results In the baseline study of 229 patients, patient age, ulcer chronicity and venous refill time (VRT) of 20 s or less were identified as risk factors. Using these factors and hazard ratios from the Cox regression analysis, the following formula was devised: Ulcerated Leg Severity Assessment (ULSA) score = age + chronicity − 50 (when VRT is greater than 20 s). Patients with an ULSA score o...
Risk Factors Associated With the Failure of a Venous Leg Ulcer to Heal
Archives of Dermatology, 1999
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, 1.38-8.45). 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.
European Journal of Vascular and Endovascular Surgery, 2005
Objective. Despite similar disease patterns and treatment, there is great variation in clinical outcome between venous ulcer patients. The aim of this study was to identify independent risk factors for venous ulcer healing and recurrence. Methods. Consecutive patients assessed by a specialist nurse-led leg ulcer service between January 1998 and July 2003 with an ABPIO0.85 were included in this study. Independent risk factors for healing and recurrence were identified from routinely assessed variables using a Cox regression proportional hazards model. Results. A total of 1324 legs in 1186 patients were studied. The 24-week healing rate was 76% and 1 year recurrence rate was 17% (Kaplan-Meier life table analysis). Patient age (p!0.001, HR per year 0.989, 95% CI 0.984-0.995) and ulcer chronicity (pZ0.019, HR per month 0.996, 95% CI 0.993-0.999) were independent risk factors for delayed ulcer healing. Ulcer healing time (p!0.001, HR per week 1.016, 95% CI 1.007-1.026) and superficial venous reflux not treated with surgery (pZ0.015, HR 2.218, 95% CI 1.166-4.218) were independent risk factors for ulcer recurrence. Conclusions. Elderly patients with longstanding ulcers should be targeted for further research and may benefit from adjunctive treatments to improve clinical outcomes. Patients not treated with superficial venous surgery were at increased risk of leg ulcer recurrence.
Influence of a specialised leg ulcer service and venous surgery on the outcome of venous leg ulcers
European Journal of Vascular and Endovascular Surgery, 1998
Objectives: To assess the influence of a vascular-led community service on the outcome of chronic leg ulcers. Design: Before and after study. Method: Healing and recurrence were compared between ulcerated limbs (n = 149)from a random sample of 200 patients treated in the community and consecutive limbs (n = 200)from 180 patients treated in specialised clinics. In these clinics, vascular disease was routinely identified with venous duplex and ankle-brachial pressure index. Surgery was offered if superficial vein reflux alone was detected. Compression bandaging was applied to limbs with ABPI >0.85. Healed limbs were treated with compression hosiery. Results: After the clinics were introduced, the 12 and 24-week healing rates increased from 12 and 29 per cent to 53 and 68 per cent respectively (p<0.01), and the 6 and 12 month recurrence rates decreased from 43 and 54 per cent to 21 and 23 per cent respectively (p<O.01). Superficial venous surgery reduced recurrence at 1 year to 9 per cent. Conclusion: Outcome of leg ulcers is improved in a vascular-led community service. Routine surgical correction, in cases of reflux limited to the superficial system, may further reduce the chance of recurrence.
Wound practice & research, 2022
Background Chronic leg ulcers affect 1-3% of the population and are costly to treat and health service resource intensive. Venous aetiology contributes to about 70% of all chronic leg ulcers; these ulcers are often associated with prolonged ill health, pain and decreased physical functioning, and have a substantial impact on health-related quality of life. Aim The primary aim of this systematic review is to identify literature on the risk factors for delayed healing or non-healing of venous leg ulcers (VLUs) in adults. Methods This systematic review will be guided by the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) 2015 statement. Studies will be identified from PubMed, ScienceDirect, Web of Science, ProQuest, CINAHL Complete, MEDLINE, APA PsychINFO, Academic Search Elite, Cochrane Library, JBI EPD (evidence-based practice database), ProQuest (Dissertations and Theses Global) and Global ETD (electronic theses and dissertations) Search Engine up to August 2021. Methodological quality will be assessed using the Mixed Methods Appraisal Tool (MMAT) 2018. A narrative synthesis of risk factors will be categorised as physiological (general/medical), clinical, demographics or psychosocial. Parker et al Delayed healing: the risks for venous leg ulcers Parker et al Delayed healing: the risks for venous leg ulcers
Chronic venous leg ulcers benefit from surgery: long-term results from 173 legs
Journal of vascular surgery, 2006
The purpose of this retrospective study was to present 7 years of data from operations of currently active, chronic venous leg ulcers (CEAP: C6), focusing on the short-and long-term effects of healing and recurrence and considering concomitant risk factors. Methods: Between January 1997 and March 2004, 173 patients (239 legs) with a currently active, chronic venous leg ulcer were surgically treated. The surgical procedures included two main steps: (1) the surgical interruption of reflux in the superficial and perforating veins to reduce venous hypertension in the entire leg and/or the affected area and (2) the surgical procedure involving the ulcer. A total of 123 patients (173 legs) who came to the follow-up were examined. The follow-up period ranged from 3 months to 7 years. The data collection integrated a preoperative examination that included medical history and clinical diagnoses and incorporated measurements such as body mass index, ankle-brachial pressure index, and the neutral position method at the follow-up. The function of the veins was measured with duplex ultrasonography. Finally, the data were analyzed by using various statistical methods, including Kaplan-Meier analysis, Cox regression analysis, and paired t tests. Results: Initially, ulcer healing occurred in 87% of the cases (151 legs). A total of 13% (22 legs) of the venous ulcers never healed, and recurrent venous ulcers occurred in 5% (9 legs). The Kaplan-Meier analyses of ulcer healing showed a healing rate of 85% in 6 months for all legs. The mean time of healing was 1.5 months. Furthermore, the Kaplan-Meier analyses of ulcer recurrence showed a 1.7% rate of recurrence in 6 months for all legs. The 5-year ulcer recurrence rate was 4.6%. The mean time of recurrence was 70.4 months. Conclusions: On the basis of the results from the 7 years of data from functional surgery of venous leg ulcers and as a result of the outcomes of our study, we recommend surgical treatment of venous leg ulcers at any stage. We therefore conclude that surgery is indicated before an ulcer is intractable to treatment. In general, our findings are based on the understanding and identification of the causes and symptoms of venous ulceration and illustrate that standard surgical methods can be applied for the therapy of venous leg ulcers at any stage.
Risk factors related to the failure of venous leg ulcers to heal with compression treatment
Journal of Vascular Surgery, 2009
Background: Compression therapy is the most widely used treatment for venous leg ulcers and it was used in different forms for more than 400 years. Published healing rates of venous ulcers obtained with compression therapy vary widely from 40-95%. According to numerous studies, it has been suggested that the application of external pressure to the calf muscle raises the interstitial pressure resulting in improved venous return and reduction in the venous hypertension. Several risk factors have been identified to be correlated with the failure of venous leg ulcers to heal with compression therapy (longer ulcer duration; large surface area; fibrinous deposition present on >50% of the wound surface and an Ankle Brachial Pressure Index (ABPI) of <0.85.
Wound Repair and Regeneration, 2016
The present status of clinical leg ulcer healing research was reviewed by 25 experts over 2 days on September 28 and 29, 2015. Multiple clinical effectiveness reviews were presented suggesting that published clinical wound healing research often does not meet present (2015) evidence based standards. Specific areas requiring remediation were highlighted and approaches to overcoming existing challenges were proposed. Participants using anonymous voting technology developed an action plan to resolve perceived deficiencies. Statements were accepted if 75% of participants agreed. Older patients with a high frequency of comorbid conditions posed particular difficulties in designing clinical research protocols and better diagnostic categorization is necessary A standardized model template for collecting information about diagnosis and evaluation of the effect of interventions on healing of all types of leg ulcers was considered a high priority. Such a model template could be modified depen...