Venous ulcers on the leg may fail to heal despite standard therapy with compression bandages. Patients at risk for poor healing may benefit from more aggressive and/or alternate therapies. The study was performed at the University of Pennsylvania in Philadelphia.
Population:
(1) Retrospective cohort study using 433 consecutive patients with chronic leg ulcers.
(2) Patients were treated using compression bandaging in an outpatient specialty clinic.
Etiology for ulceration:
(1) venous disease
(2) arterial insufficiency
(3) insensate neuropathy
Factors Associated with Healing Failure Within 24 Weeks
Factor
Odds Ratio
95% Confidence Interval
large wound area
1.19
1.11 - 1.27
duration of wound in months
1.09
1.04 - 1.16
history of venous ligation or venous stripping
4.58
1.84 - 11.36
history of hip or knee replacement surgery
3.52
1.12 - 11.08
ankle brachial index < 0.80
3.52
1.12 - 11.08
presence of fibrin over > 50% of wound surface
3.42
1.38 - 8.45
Odds Ratio for Healing Failure Based on Ulcer Size and Duration
2 months
6 months
12 months
18 months
5 cm^2
1.99
2.28
2.77
3.36
10 cm^2
4.16
5.43
8.01
11.82
15 cm^2
7.60
11.29
20.23
36.24
after Table 2, page 923
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