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Leg ulcers
Hard-to-heal wounds

Ulcer area reduction at 2 weeks predicts failure to heal by 24 weeks in the venous leg ulcers of patients living alone

02 April 2017
Research
02 April 2017
Volume 1 · Issue 2

Abstract

Objective:

Chronic wounds are costly and affect approximately 1–2% of the population. Venous disease is responsible for about 60% of all chronic leg ulcers and these ulcers can be debilitating, with evidence of a decreased quality of life. Unfortunately, up to 30% of venous leg ulcers (VLUs) fail to heal, despite best practice treatment. This study aimed to identify risk factors associated with delayed healing in participants with VLUs and in particular, whether psychosocial factors play a part in this process.

Method:

A secondary analysis was conducted of a large data set of clinical, wound healing, health, social, economic and psychological data collected in previous prospective studies of participants with VLUs. Generalised linear mixed modelling was used to identify independent predictors of failure to heal after 24 weeks.

Results:

We recruited 247 participants with 318 VLUs from hospital and community settings. Findings revealed that four early predictors were independently significantly associated with failure to heal by 24 weeks. These were: participants who lived alone (OR 2.3, 95%CI [1.13–4.61], p=0.03); had less than 25% reduction in ulcer area within two weeks of treatment (OR 10.07, 95%CI [4.60–22.19], p<0.001); had higher ulcer severity scores (OR 5.1, 95%CI [2.33–11.88], p=0.001); and participants who were not treated with high level compression therapy (i.e.>30 mmHg) at the time of assessment (OR 4.18, 95% CI [1.95–8.97], p=0.002).

Conclusion:

Identified risk factors offer an opportunity for clinicians to determine realistic outcomes for their patients and to guide decisions on early referral and implementation of tailored adjunctive interventions. Additionally, findings from this study suggest health professionals need to assess and address not only clinical risk factors but also social risk factors, when planning interventions to promote healing.

Despite many advances in wound care, chronic leg ulcers still pose a considerable burden today for patients, carers and the health-care system. Leg ulcers affect approximately 1–2 % of the population.1 Chronic venous insufficiency or venous disease contributes to approximately 60 % of all chronic leg ulcers.2

A chronic venous leg ulcer (VLU) has been defined as an ulcer that fails to proceed through an orderly process to produce anatomic and functional integrity and does not heal within a four to six-week period.2 VLUs generally occur in the distal portion of the lower limbs, are shallow and moist, with an irregular shape; they are often associated with venous eczema, haemosiderin pigmentation, ankle oedema, ankle flare, and lipodermatosclerosis.3 These ulcers can vary in size, ranging from single, small ulcers to multiple ulcers and/or encompassing the full circumference of the leg.4

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delayed healing
generalised linear mixed modelling
non-healing
risk factors
venous leg ulcer
living alone