Influence of a specialised leg ulcer service and venous surgery on the outcome of venous leg ulcers

Ghauri, A. S. K.; Nyamekye, Isaac; Grabs, Anthony J.; Farndon, J. R.; Whyman, M. R.; Poskitt, K. R.

doi:10.1016/s1078-5884(98)80226-8

Cited by 56 publications

(43 citation statements)

References 24 publications

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“…It may be that compression bandaging or elastic stockings are less 51 effective at counteracting venous insufficiency in the popliteal segment of the deep venous system. Surgical correction of isolated superficial venous disease seems to protect against ulcer recurrence as has been shown in our earlier work [30] and by other authors [8,31]. Poor compliance with compression bandaging or stockings has been suggested as a reason for low healing and high recurrence rates in chronic leg ulcers [32].…”

Section: Discussionsupporting

confidence: 53%

Risk Factors for Healing and Recurrence of Chronic Venous Leg Ulcers

et al. 2000

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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.

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Section: Discussionsupporting

confidence: 53%

Risk Factors for Healing and Recurrence of Chronic Venous Leg Ulcers

et al. 2000

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“…30 In our study 24% of patients randomised to surgery refused to attend for their operation despite extensive counselling before recruitment. Moreover, patients waited a median of seven weeks for their operation and therefore may not have received an immediate benefit.…”

Section: Discussionmentioning

confidence: 71%

Long term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (ESCHAR): randomised controlled trial

Gohel

Barwell

Taylor

et al. 2007

BMJ

352

258

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Objective To determine whether recurrence of leg ulcers may be prevented by surgical correction of superficial venous reflux in addition to compression.Design Randomised controlled trial.Setting Specialist nurse led leg ulcer clinics in three UK vascular centres.Participants 500 patients (500 legs) with open or recently healed leg ulcers and superficial venous reflux.Interventions Compression alone or compression plus saphenous surgery.Main outcome measures Primary outcomes were ulcer healing and ulcer recurrence. The secondary outcome was ulcer free time.Results Ulcer healing rates at three years were 89% for the compression group and 93% for the compression plus surgery group (P=0.73, log rank test). Rates of ulcer recurrence at four years were 56% for the compression group and 31% for the compression plus surgery group (P<0.01). For patients with isolated superficial reflux, recurrence rates at four years were 51% for the compression group and 27% for the compress plus surgery group (P<0.01). For patients who had superficial with segmental deep reflux, recurrence rates at three years were 52% for the compression group and 24% for the compression plus surgery group (P=0.04). For patients with superficial and total deep reflux, recurrence rates at three years were 46% for the compression group and 32% for the compression plus surgery group (P=0.33). Patients in the compression plus surgery group experienced a greater proportion of ulcer free time after three years compared with patients in the compression group (78% v 71%; P=0.007, Mann-Whitney U test).Conclusion Surgical correction of superficial venous reflux in addition to compression bandaging does not improve ulcer healing but reduces the recurrence of ulcers at four years and results in a greater proportion of ulcer free time.Trial registration Current Controlled Trials ISRCTN07549334.

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“…Venous leg ulcers received compression therapy, 70% of leg ulcers have been reported to heal within 3 months by this therapy (1,15,16).…”

Section: Wound Diagnostic and Standard Treatmentmentioning

confidence: 99%

Epidemiology of Chronic Wound Patients and Relation to Serum Levels of Mannan-binding Lectin

Bitsch¹,

Laursen²,

Engel³

et al. 2009

Acta Derm Venerol

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The aim of this study was to describe the epidemiology of chronic wounds in a large cohort of patients from a tertiary hospital out-patient clinic, and examine the significance of serum mannan-binding lectin for the occurrence and clinical presentation of such wounds. The study comprised 489 consecutive patients with chronic foot and leg ulcers. A clinical classification of wound- aetiology was performed, and mannan-binding lectin was measured in the sera of patients and healthy controls. The patients presented with 639 wounds altogether; diabetic foot ulcers (309), venous leg ulcers (188), arterial ulcers (109), and vasculitis (33). The mannan-binding lectin levels of patients with venous leg ulcer, alone or in combination with other types of wounds, differed significantly from the control group, and the frequency of values < 100 ng/ml was significantly higher. In diabetic and arterial ulcer patients the frequency of values >or= 3000 ng/ml was significantly higher than that of the control group. This suggests a role for the innate immunity in the pathology of venous leg ulcers, and indicates different roles for mannan-binding lectin in the development of ulcers with different aetiologies; it further suggests that mannan-binding lectin substitution should be tested in a controlled clinical trial.

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Influence of a specialised leg ulcer service and venous surgery on the outcome of venous leg ulcers

Abstract: Outcome of leg ulcers is improved in a vascular-led community service. Routine surgical correction, in cases of reflux limited to the superficial system, may further reduce the chance of recurrence.

Cited by 56 publications

References 24 publications

Risk Factors for Healing and Recurrence of Chronic Venous Leg Ulcers

Risk Factors for Healing and Recurrence of Chronic Venous Leg Ulcers

Long term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (ESCHAR): randomised controlled trial

Epidemiology of Chronic Wound Patients and Relation to Serum Levels of Mannan-binding Lectin

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