Prognostic factors for delayed healing of venous leg ulcers

Abstract

Risk factors of poor healing of venous leg ulcers can be categorised into three main groups: those related to the ulcer, those related to the patient, and those related to the organisation of wound care. Identification of risk factors that predispose these patients to prolonged wound healing not only offers an opportunity to determine their clinical outcome, but can also be linked to the decision regarding alternative interventions or even reorganisation of the wound care. Factors related to the ulcer comprise large ulcer size and long ulcer duration. Also, some macroscopic features of venous leg ulcers are associated with delayed healing: fibrin covering more than 50% of the area of the wound and highly exuding ulcers. Coexisting non-venous vascular pathologies, such as arterial ischaemia or clinically relevant lymphedema, as well as history of deep vein thrombosis, can contribute to delayed healing. Additionally, pathological functioning of calf muscle pump can be associated with reduced healing. Some bacterium species seem to interfere with healing of venous leg ulcers, especially if the number of such microorganisms in the wound bed is high. Regarding patient characteristics, reduced mobility (patients being chair or bedbound) is a risk factor, while it remains unclear whether the demographic characteristics of the patients or their non-vascular co-morbidities are really associated with impaired healing. In addition, a number of studies have shown that organisation of wound care of venous leg ulcer patients appeared to be important, and healing rates improved and the cost of care declined after the implementation of an evidence-based service.

A Combined Therapy Protocol to Improve Lower Extremity Muscle-Pumping Function and Lymphatic Drainage for Venous Ulcer Healing

“…For studies using diameters as a metric, some have established the cut-point at 10 centimeters [33]. In contrast, small ulcers of 1 centimeter or less, were more likely to heal within a short period [34]. Moreover, several studies with relatively small samples or high-sample heterogeneity have failed to demonstrate an association between size and time to heal [35,36].…”

Clinical meaning of incompetent perforators in the setting of post-thrombotic syndrome commentary

“…It is already known that the recurrence rate of incompetent perforators is very high, both after low-invasive treatments and after surgical ligation. It is also known that recurrence of ulcers is particularly high in post-thrombotic limbs [13][14][15], even after invasive management of perforators. Therefore, even if in selected cases of post-thrombotic syndrome these perforators should be managed (especially if they are the only source of reflux feeding the varicose veins and are likely to transmit a high venous pressure from the deep veins to the veins of the skin), it should be acknowledged that many of them will recur, irrespective of the method used for their closure, and that clinical improvement will not be permanent.…”