Document Detail


Factors associated with poor healing and recurrence of venous ulceration.
MedLine Citation:
PMID:  21915079     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Plastic surgeons are often approached for wound management and closure of chronic venous ulcers that fail to heal despite multimodal management. The authors present a retrospective analysis of a large series of venous ulcers to determine factors predicting nonhealing and recurrence.
METHODS: Consecutive patients with chronic venous ulcers (≥ 2-cm diameter) were examined for the presence of superficial, perforating, or deep venous disease, including reflux and/or obstruction. Treatment included compression, venous ligation, stripping, thermal ablation, sclerotherapy, and local wound care. Ulcers refractory to 6 months of treatment were defined as nonhealing ulcers. Data were analyzed for differences in baseline patient and ulcer characteristics and clinical course of nonhealing ulcers. Data were compared using Wilcoxon rank sum, chi-square, and Fisher's exact tests using Sigma Stat and SPSS, with α set at p < 0.05.
RESULTS: The authors identified 153 ulcers in 127 patients. Factors associated with ulcer nonhealing included advanced age, increased body mass index, history of deep venous thrombosis, noncompliance with compression therapy, and large ulcer area. One hundred thirty-one of the ulcers (85.6 percent) healed within 6 months and 147 (96 percent) of the ulcers ultimately healed without the need for operative plastic surgical intervention.
CONCLUSIONS: A thorough understanding of risks and expected clinical course is required for assessment of the nonhealing venous ulcer. The authors recommend identification and correction of underlying venous abnormality and a minimum of at least 6 months of compression and local wound care followed by reassessment of venous function before operative plastic surgical intervention should be considered.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
Authors:
Nicos Labropoulos; Eric D Wang; Steven T Lanier; Sami U Khan
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Plastic and reconstructive surgery     Volume:  129     ISSN:  1529-4242     ISO Abbreviation:  Plast. Reconstr. Surg.     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2011-12-26     Completed Date:  2012-03-06     Revised Date:  2012-09-10    
Medline Journal Info:
Nlm Unique ID:  1306050     Medline TA:  Plast Reconstr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  179-86     Citation Subset:  AIM; IM    
Affiliation:
Division of Vascular Surgery, Department of Surgery, the School of Medicine, Stony Brook University Medical Center, Health Sciences Center, Stony Brook, NY 11794-8191, USA. nlabrop@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Chronic Disease
Female
Humans
Ligation
Male
Microcirculation
Middle Aged
Recurrence
Risk Factors
Sclerotherapy
Treatment Failure
Ultrasonography, Doppler, Duplex
Varicose Ulcer / epidemiology,  physiopathology,  surgery,  therapy*,  ultrasonography
Veins / surgery
Wound Healing* / physiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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