Clinical predictors of leg ulcer healing

Moffatt, C.J., Doherty, D.C., Smithdale, R. and Franks, P.J. (2010) Clinical predictors of leg ulcer healing. British Journal of Dermatology, 162(1), pp. 51-58. (doi: 10.1111/j.1365-2133.2009.09397.x)

Abstract

Background:  Identification of factors associated with healing can help in understanding the causes of delayed healing in chronic leg ulceration, and can allow for programmes to be developed to modify these factors to improve patient outcomes.

Objectives:  To determine factors associated with healing in patients with chronic leg ulceration of all types within a defined patient population.

Methods:  The patients were identified within the combined acute/community leg ulcer service within Wandsworth Primary Care Trust. All identified patients agreed to be interviewed and those who were able underwent clinical and noninvasive testing to determine the cause of the ulceration. Follow ups were to a maximum of 48 weeks, with time to healing given as the principal outcome measure. Analysis was by the Cox proportional hazards model for both univariate and multivariate analysis. Results were expressed as hazard ratio with 95% confidence intervals derived from the models.

Results:  In total, 113 patients took part in this study. Univariate analysis revealed statistically significant differences for delayed healing according to the ulcer duration (P = 0·002), complexity of the ulcer aetiology (P = 0·035), presence of lipodermatosclerosis (P = 0·02), history of deep vein thrombosis (DVT) (P = 0·03) and thrombophlebitis (P = 0·03). Multivariate analysis showed that ulcer duration (P = 0·014), DVT (P = 0·008) and a lack of Pseudomonas on wound swab (P = 0·005) were independently associated with delayed healing.

Conclusions:  The results indicate the complexity of determining risk factors for poor healing in patients with chronic leg ulceration. There appears to be little scope for interventions to improve healing from the factors identified.

• Item Type: Articles
• Keywords: Aetiology, healing, leg ulcer, risk factors
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Franks, Professor Peter
• Authors: Moffatt, C.J., Doherty, D.C., Smithdale, R., and Franks, P.J.
• Subjects: R Medicine > RL Dermatology
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Nursing and Health Care
• Journal Name: British Journal of Dermatology
• Publisher: Wiley-Blackwell
• ISSN: 0007-0963
• ISSN (Online): 1365-2133