Chaby et al identified factors associated with healing of a chronic venous leg ulcer. These can help to identify a patient who may benefit from more aggressive management. The authors are from multiple hospitals in France.
Patient selection: large chronic venous leg ulcer
Outcome: healing at week 24
Parameters:
(1) wound area at baseline in square cm
(2) wound area at 4 weeks in square cm
(3) wound area at 24 weeks in square cm
If more than 1 ulcer was present in a lower extremity, then the total ulcer area was the sum of individual ulcer areas.
reduction in wound area at 4 weeks =
= ((area at baseline) - (area at 4 weeks)) / (area at baseline)
reduction in wound area at 24 weeks =
= ((area at baseline) - (area at 24 weeks)) / (area at baseline)
Factors associated with healing on multivariate analysis:
(1) ablation of incompetent superficial veins associated with the ulcer (which reduces venous pressure to the ulcer)
(2) rate of wound healing at week 4
A reduction in wound area at 4 weeks <= 30% was associated with poor wound healing at 24 weeks.
Additional factors found on univariate analysis:
(1) adherence to compression therapy at 4 weeks
(2) adherence to compression therapy at 24 weeks
(3) ankylosis of the ankle joint (associated with calf muscle pump dysfunction)
Other factors not identified in the analysis:
(1) protein malnutrition (discussed in text)
(2) medications associated with poor wound healing
