Clinical studiesWhich venous leg ulcers will heal with limb compression bandages?☆
Section snippets
Study design and samples
The modeling data set was a retrospective cohort study of 260 consecutive patients with chronic venous leg ulcers who were treated in the Cutaneous Ulcer Center of the Department of Dermatology of the University of Pennsylvania Medical Center between 1993 and 1995. Patients were classified as having a venous leg ulcer if their wound was located in the “gaiter” area of the limb (ie, an area extending from the mid calf to approximately 1 inch below the malleolus). In addition, they must have had
Results
Patients in the modeling and validation data sets had generally similar demographic and clinical characteristics (Table 1). Overall, by the 24th week of care, ulcers had healed in 65% of the patients in the modeling data set and in 56% of the patients in the validation data set. In the modeling data set, 85% of the patients with ulcers ≤5 cm2 healed, and 88% of wounds ≤6 months in duration healed. In the validation data set, 76% of the wounds ≤5 cm2 healed, and 90% of wounds ≤6 months in
Discussion
We developed several models of varying complexity that can be used to predict the probability that a venous leg ulcer will heal in a timely fashion using a limb compression bandage. Our results indicated that the likelihood that a venous leg ulcer will heal can be estimated simply by asking about the age of the wound and measuring its area at a patient’s initial evaluation. Although previous studies have evaluated prognostic factors associated with the healing of venous leg ulcers 24, 33, 34, 35
Acknowledgements
The authors would like to thank Daniel Mines, MD, MSCE, James Lewis, MD, MSCE, and Fay Wright, MD, for their critical review of this manuscript; and Ms. S. Masiak and Ms. A. Nesmith for their technical support.
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2019, Journal of Vascular Surgery: Venous and Lymphatic DisordersCitation Excerpt :An additional analysis of ulcer size was conducted; rather than considering size as a continuous variable, we assigned ulcers into one of three categories, <5 cm2, 5-20 cm2, and >20 cm2, similar to the study conducted by Marston et al.18 Ulcers >20 cm2 were shown to be significant for nonhealing in univariate analysis, but when corrected for other factors in multivariate analysis, the effect of size on VLU healing was again negligible. Previous studies have also consistently shown that ulcer duration before initiation of treatment is associated with delayed healing.6,11,15-17,19,20 One limitation of our study is that duration of ulcer before treatment was not consistently available because of lack of this specific information on a retrospective chart review.
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Supported in part by a Career Development award from the Dermatology Foundation and Grant AG 00715 from the National Institutes of Health.