SLR - January 2010 - Jessica L. Prebish
Reference:
Milic, D.J., Zivic , S.S., Bogdanovic, D.C., Karanovic, N.D., and Goluovic, Z.V. (2009). Risk factors related to the failure of venous leg ulcers to heal with compression treatment. Journal of Vascular Surgery, 49, 1242-1247.
Scientific Literature Reviews
Reviewed by: Jessica L. Prebish, DPM
Residency Program: Kaiser North Bay Consortium, Vallejo
Podiatric Relevance:
Venous leg ulcers are commonly treated by foot and ankle surgeons. The most commonly used treatment for venous ulcers is compression therapy. Published data has shown that the healing rate of venous ulcers using compression therapy varies greatly. Several studies have identified risk factors associated with non-healing tendency, but these studies have had only short term patient follow up.
Methods:
In this open, prospective, single-center study, risk factors associated with failure of venous ulcers to heal when treated with multi-layer compression therapy was determined. A total of 189 patients with venous ulcers were treated with simple wound debridement with sterile gauze and a multi-layer compression dressing. Wound healing was assessed at 26 weeks and again at 52 weeks at which time patients were classified into 3 groups: patients with unhealed ulcers, patients with healed ulcers at 26 weeks, and those with healed ulcers at 52 weeks. Analysis of potential risk factors associated with the failure of venous ulcer healing were then determined among the three groups.
Results:
The healing rate of venous ulcers at 26 weeks and 52 weeks was 50.26% and 87.3% respectively. It was found that age, sex, previous surgery, and ulcer recurrence had no influence on wound healing. Ulcerations with surface area greater that 20 cm2 , wound duration longer than 12 months, ulcer depth >2cm, BMI higher than 33kg/m2 , daily walking distance shorter than 200 meters, history of surgical wound debridement, and >50% surface area of the wound covered by fibrin significantly increased the odds of not healing in 26 weeks. Favorable prognostic factors for wound healing were found to be a decrease in calf circumference by >3cm in the first 50 days of treatment and the emergence of new skin islands covering greater than 10% of the surface area. Calf-ankle circumference ratio <1.3 and fixed or decreased ankle range of motion were the only independent risk factors associated with non-healing.
Conclusions:
This study confirmed previous reports that certain risk factors are associated with poor wound healing and non-healing. Contrary to some previously published reports, this study did identify that large chronic wounds could be healed with long term compression therapy. While large chronic venous ulcers are some of the most difficult ulcers to treat, this study demonstrated the efficacy of compression treatment.