Top

American Journal of Clinical Dermatology

Published in:

01-10-2016 | Original Research Article

Critical Evaluation of Delayed Healing of Venous Leg Ulcers: A Retrospective Analysis in Canadian Patients

Authors: Gary K. Yang, Sarah Cao, Ahmed Kayssi, Andrew D. Dueck, Afsaneh Alavi

Published in: American Journal of Clinical Dermatology | Issue 5/2016

Abstract

Background

Venous leg ulcers (VLUs) are common but challenging health problems. Better understanding of the risk factors involved in delayed healing of VLUs may therefore guide individualized treatment plans to improve patient outcomes.

Objective

We sought to identify the risk factors associated with delayed healing of VLUs in patients seen at a tertiary academic wound care clinic.

Methods

A retrospective analysis of 554 patients who presented to the Toronto Regional Wound Healing Clinic for VLUs in a 3-year period was performed. Patient and ulcer characteristics were recorded. Multivariate analyses were performed to compare patients with ulcer resolution and those whose ulcers did not resolve after 12-month follow-up.

Results

The average age of the patients was 67.3 ± 0.7 years, with 56 % being female. The most common comorbidities were hypertension (54 %), dyslipidemia (33 %), a history of smoking (30 %), and diabetes (26 %). Ulcer resolution was associated with a smaller ulcer size (odds ratio [OR] 0.984 [95 % confidence interval (CI) 0.973, 0.996]), shorter ulcer duration (OR 0.704 [95 % CI 0.574, 0.865]), and dyslipidemia (OR 1.848 [95 % CI 1.052, 3.246]).

Conclusion

Pro-healing factors associated with VLUs were a smaller ulcer size and a shorter ulcer duration. Dyslipidemia was also associated with improved healing, potentially owing to the use of statins. Patients presenting with poorer-prognosis VLUs should receive more aggressive treatment with earlier referral to vascular surgery.

O’Donnell TF Jr, Passman MA, Marston WA, Ennis WJ, Dalsing M, Kistner RL, et al. Management of venous leg ulcers: clinical practice guidelines of the Society for Vascular Surgery (R) and the American Venous Forum. J Vasc Surg. 2014;60(2 Suppl):3S–59S.CrossRefPubMed

Palfreyman S. Assessing the impact of venous ulceration on quality of life. Nurs Times. 2008;104(41):34–7.PubMed

Persoon A, Heinen MM, van der Vleuten CJ, de Rooij MJ, van de Kerkhof PC, van Achterberg T. Leg ulcers: a review of their impact on daily life. J Clin Nurs. 2004;13(3):341–54.CrossRefPubMed

Todd M. Venous leg ulcers and the impact of compression bandaging. Br J Nurs. 2011;20(21):1360–4.CrossRefPubMed

Finlayson K, Edwards H, Courtney M. Factors associated with recurrence of venous leg ulcers: a survey and retrospective chart review. Int J Nurs Stud. 2009;46(8):1071–8.CrossRefPubMed

Nelson EA, Harper DR, Prescott RJ, Gibson B, Brown D, Ruckley CV. Prevention of recurrence of venous ulceration: randomized controlled trial of class 2 and class 3 elastic compression. J Vasc Surg. 2006;44(4):803–8.CrossRefPubMed

Clarke-Moloney M, Keane N, O’Connor V, Ryan MA, Meagher H, Grace PA, et al. Randomised controlled trial comparing European standard class 1 to class 2 compression stockings for ulcer recurrence and patient compliance. Int Wound J. 2014;11(4):404–8.CrossRefPubMed

Abbade LP, Lastoria S, Rollo Hde A. Venous ulcer: clinical characteristics and risk factors. Int J Dermatol. 2011;50(4):405–11.CrossRefPubMed

Gschwandtner ME, Ehringer H. Microcirculation in chronic venous insufficiency. Vasc Med. 2001;6(3):169–79.CrossRefPubMed

10.

Finlayson K, Edwards H, Courtney M. The impact of psychosocial factors on adherence to compression therapy to prevent recurrence of venous leg ulcers. J Clin Nurs. 2010;19(9–10):1289–97.CrossRefPubMed

11.

Nelson EA, Bell-Syer SE. Compression for preventing recurrence of venous ulcers. Cochrane Database Syst Rev. 2014;9:CD002303.PubMed

12.

O’Meara S, Cullum N, Nelson EA, Dumville JC. Compression for venous leg ulcers. Cochrane Database Syst Rev. 2012;11:CD000265.PubMed

13.

Arpaia G, Milani M, Addeo R, Crespi A, Feltri R, Ricci E, et al. Clinical validation of a specially sized class II compression knee-sock for the prevention of recurrent ulcers in patients with chronic venous stasis (CEAP 5). Int Angiol. 2008;27(6):507–11.PubMed

14.

Sackheim K, De Araujo TS, Kirsner RS. Compression modalities and dressings: their use in venous ulcers. Dermatol Ther. 2006;19(6):338–47.CrossRefPubMed

15.

Thomson B, Hooper P, Powell R, Warin AP. Four-layer bandaging and healing rates of venous leg ulcers. J Wound Care. 1996;5(5):213–6.PubMed

16.

Hedayati N, Carson JG, Chi YW, Link D. Management of mixed arterial venous lower extremity ulceration: a review. Vasc Med. 2015;20(5):479–86.CrossRefPubMed

17.

Margolis DJ, Berlin JA, Strom BL. Risk factors associated with the failure of a venous leg ulcer to heal. Arch Dermatol. 1999;135(8):920–6.CrossRefPubMed

18.

Prince S, Dodds SR. Use of ulcer size and initial responses to treatment to predict the healing time of leg ulcers. J Wound Care. 2006;15(7):299–303.CrossRefPubMed

19.

Kahn SR, Comerota AJ, Cushman M, Evans NS, Ginsberg JS, Goldenberg NA, et al. The postthrombotic syndrome: evidence-based prevention, diagnosis, and treatment strategies: a scientific statement from the American Heart Association. Circulation. 2014;130(18):1636–61.CrossRefPubMed

20.

Labropoulos N, Wang ED, Lanier ST, Khan SU. Factors associated with poor healing and recurrence of venous ulceration. Plast Reconstr Surg. 2012;129(1):179–86.CrossRefPubMed

21.

Marston WA, Carlin RE, Passman MA, Farber MA, Keagy BA. Healing rates and cost efficacy of outpatient compression treatment for leg ulcers associated with venous insufficiency. J Vasc Surg. 1999;30(3):491–8.CrossRefPubMed

22.

Georgopoulos S, Kouvelos GN, Koutsoumpelis A, Bakoyiannis C, Lymperi M, Klonaris C, et al. The effect of revascularization procedures on healing of mixed arterial and venous leg ulcers. Int Angiol. 2013;32(4):368–74.PubMed

23.

Baker SR, Stacey MC, Jopp-McKay AG, Hoskin SE, Thompson PJ. Epidemiology of chronic venous ulcers. Br J Surg. 1991;78(7):864–7.CrossRefPubMed

24.

Hohn L, Chiarenza S, Schmied E, Bounameaux H. Age-related rather than ulcer-related impairment of venous function tests in patients with venous ulceration. Dermatologica. 1990;180(2):73–5.CrossRefPubMed

25.

Collins L, Seraj S. Diagnosis and treatment of venous ulcers. Am Fam Phys. 2010;81(8):989–96.

26.

Milic DJ, Zivic SS, Bogdanovic DC, Karanovic ND, Golubovic ZV. Risk factors related to the failure of venous leg ulcers to heal with compression treatment. J Vasc Surg. 2009;49(5):1242–7.CrossRefPubMed

27.

Skene AI, Smith JM, Dore CJ, Charlett A, Lewis JD. Venous leg ulcers: a prognostic index to predict time to healing. BMJ. 1992;305(6862):1119–21.CrossRefPubMedPubMedCentral

28.

Kecelj Leskovec N, Perme MP, Jezersek M, Mozina J, Pavlovic MD, Lunder T. Initial healing rates as predictive factors of venous ulcer healing: the use of a laser-based three-dimensional ulcer measurement. Wound Repair Regen. 2008;16(4):507–12.CrossRefPubMed

29.

Hjerppe A, Saarinen JP, Venermo MA, Huhtala HS, Vaalasti A. Prolonged healing of venous leg ulcers: the role of venous reflux, ulcer characteristics and mobility. J Wound Care. 2010;19(11):474, 476, 478 (passim).

30.

Evangelista MT, Casintahan MF, Villafuerte LL. Simvastatin as a novel therapeutic agent for venous ulcers: a randomized, double-blind, placebo-controlled trial. Br J Dermatol. 2014;170(5):1151–7.CrossRefPubMed

31.

Farsaei S, Khalili H, Farboud ES. Potential role of statins on wound healing: review of the literature. Int Wound J. 2012;9(3):238–47.CrossRefPubMed

32.

Kuwana M, Kaburaki J, Okazaki Y, Yasuoka H, Kawakami Y, Ikeda Y. Increase in circulating endothelial precursors by atorvastatin in patients with systemic sclerosis. Arthritis Rheum. 2006;54(6):1946–51.CrossRefPubMed

33.

Vasa M, Fichtlscherer S, Adler K, Aicher A, Martin H, Zeiher AM, et al. Increase in circulating endothelial progenitor cells by statin therapy in patients with stable coronary artery disease. Circulation. 2001;103(24):2885–90.CrossRefPubMed

34.

Kureishi Y, Luo Z, Shiojima I, Bialik A, Fulton D, Lefer DJ, et al. The HMG-CoA reductase inhibitor simvastatin activates the protein kinase Akt and promotes angiogenesis in normocholesterolemic animals. Nat Med. 2000;6(9):1004–10.CrossRefPubMedPubMedCentral

35.

Bitto A, Minutoli L, Altavilla D, Polito F, Fiumara T, Marini H, et al. Simvastatin enhances VEGF production and ameliorates impaired wound healing in experimental diabetes. Pharmacol Res. 2008;57(2):159–69.CrossRefPubMed

36.

Chang AC, Dearman B, Greenwood JE. A comparison of wound area measurement techniques: Visitrak versus photography. Eplasty. 2011;11:e18.PubMedPubMedCentral

Title: Critical Evaluation of Delayed Healing of Venous Leg Ulcers: A Retrospective Analysis in Canadian Patients
Authors: Gary K. Yang
Sarah Cao
Ahmed Kayssi
Andrew D. Dueck
Afsaneh Alavi
Publication date: 01-10-2016
Publisher: Springer International Publishing
Published in: American Journal of Clinical Dermatology / Issue 5/2016
Print ISSN: 1175-0561
Electronic ISSN: 1179-1888
DOI: https://doi.org/10.1007/s40257-016-0214-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Critical Evaluation of Delayed Healing of Venous Leg Ulcers: A Retrospective Analysis in Canadian Patients

Abstract

Background

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objective

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2016

Adalimumab: A Review in Hidradenitis Suppurativa

Amyopathic Dermatomyositis: A Concise Review of Clinical Manifestations and Associated Malignancies

Evaluation of Oxidant–Antioxidant Balance in Children with Atopic Dermatitis: A Case–Control Study

Chronic Pruritus and Connective Tissue Disorders: Review, Gaps, and Future Directions

Cutaneous Squamous Cell Carcinoma: A Review of High-Risk and Metastatic Disease

Immunologic Targets in Atopic Dermatitis and Emerging Therapies: An Update