Risk Factors for Healing and Recurrence of Chronic Venous Leg Ulcers

Abstract

Objective:

To identify independent risk factors for delayed healing and increased recurrence of chronic venous leg ulcers.

Design:

Prospective study.

Setting:

Community-based leg ulcer service.

Patients:

Six hundred and thirty-three limbs in 587 consecutive patients with an ankle-brachial pressure index (ABPI) ≥0.85.

Method:

Potential risk factors were initially assessed in a one-stop clinic incorporating clinical evaluation, ABPI and venous duplex imaging. Limbs were treated within a defined protocol. Twenty-four-week healing and 3-year ulcer recurrence rates were determined.

Results:

Of 12 potential risk factors age (p< 0.001), ulcer chronicity (p< 0.001) and popliteal vein reflux (p< 0.005) were independent risks for delayed healing. Of 13 potential risk factors rheumatoid arthritis (p<0.005) and healing time (p < 0.05) were independent risks for ulcer recurrence. Isolated superficial venous reflux treated by saphenous vein surgery predicted reduced ulcer recurrence (p< 0.005).

Conclusion:

Targeting in primary care of ulcer patients with specific characteristics might encourage earlier referral and appropriate resource management. Leg ulcer patients with superficial venous reflux might benefit from surgical correction.