References
Healing outcomes and predictors among patients with venous leg ulcers treated with compression therapy
Abstract
Objective:
This study aimed to compare the healing outcomes between three types of compression therapy—two-layer bandage (2LB), four-layer bandage (4LB), and compression stockings, and to identify the predictors of venous leg ulcer (VLU) healing
Method:
A retrospective review of the medical records of patients diagnosed with VLU between 2011 and 2016 in Singapore was conducted. Univariate and multivariate analyses were done between healed and unhealed VLU patients at three and six months, based on potential factors, ranging from demographic profile to comorbidities and treatment-related variables.
Results:
Data from 377 patients' medical records were analysed. The healing rates with the three types of compression system, 4LB, 2LB and compression stockings, were 22.3%, 34.9% and 8.7% respectively at three months; at six months they were 44.2%, 41.9% and 34.8% respectively. Patients on 2LB reported a significantly higher proportion of healed ulcers at three months (p=0.003) but at six months there was no difference in healing rates between the three types of therapy. At three and six months, the duration of compression therapy was found to be an independent predictor of healing (p<0.001).
Conclusion:
In this study, the 2LB appeared to show the most favourable healing outcome in the short-term but as VLUs persisted beyond the months, the type of compression system used did not make a difference in the healing outcome. Our findings suggested that, as the duration became more prolonged, VLUs became more resistant to healing despite compression therapy. Therefore, it may be necessary for clinicians to consider adjuvant therapies for hard-to-heal ulcers at an earlier stage.
Venous leg ulcers (VLUs) are the commonest type of lower extremity ulcers and are closely related to chronic venous insufficiency.1 Older people are particularly at risk of developing them because of age-related conditions, as well as frailty.2 The precise global prevalence of VLUs is difficult to estimate because of the variety of methodologies used in studies and the accuracy of reporting. Nonetheless, it is estimated that approximately 1% of the global population and 4% of older adults aged >65 years old are affected by VLUs.3
VLUs have significant human and economic burdens, at both individual and societal levels, because they take a long time to heal and have a high recurrence rate.4,5 Globally, it is estimated that 93% of VLUs heal in 12 months and that 7% remain unhealed after five years, while the recurrence rate within three months of healing is around 70%.3 In the UK, the reported healing rate of VLUs was 53% within 12 months, and the average time to healing was 30 months.6 In Asia, including in Singapore, the healing rate of VLUs has not been published so a comparison cannot be made.
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