Clinical studies
Which venous leg ulcers will heal with limb compression bandages?

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Abstract

PURPOSE: To develop a simple prediction rule to identify patients in whom a venous leg ulcer will heal using a limb compression bandage (eg, Unna’s boot).

SUBJECTS AND METHODS: We performed a retrospective cohort study of patients with venous leg ulcers who received a limb compression bandage applied weekly. Prognostic factors were assessed from the patient’s history before the start of treatment. The outcome of interest was a healed wound within 24 weeks of treatment. The final model was validated in another data set.

RESULTS: Several accurate prognostic models were developed. The simplest model summed the size and duration of the wound before treatment, with 1 point given for a wound with an area >5 cm2 and another if the wound was >6 months old. In the development data set, ulcers healed in 93% (110 of 118) of patients with a score of 0, but in only 13% (9 of 67) of those with a score of 2. In the validation data set, ulcers healed in 95% (19 of 20) of patients with a score of 0, and 37% (44 of 120) of those with a score of 2.

CONCLUSIONS: This simple prognostic model can be used to discriminate between patients with a venous leg ulcer that will or will not heal within 24 weeks of care with a limb compression bandage. The model may be useful in determining which patients to treat with a limb compression, and which patients should be referred or considered for alternative treatments.

Section snippets

Study design and samples

The modeling data set was a retrospective cohort study of 260 consecutive patients with chronic venous leg ulcers who were treated in the Cutaneous Ulcer Center of the Department of Dermatology of the University of Pennsylvania Medical Center between 1993 and 1995. Patients were classified as having a venous leg ulcer if their wound was located in the “gaiter” area of the limb (ie, an area extending from the mid calf to approximately 1 inch below the malleolus). In addition, they must have had

Results

Patients in the modeling and validation data sets had generally similar demographic and clinical characteristics (Table 1). Overall, by the 24th week of care, ulcers had healed in 65% of the patients in the modeling data set and in 56% of the patients in the validation data set. In the modeling data set, 85% of the patients with ulcers ≤5 cm2 healed, and 88% of wounds ≤6 months in duration healed. In the validation data set, 76% of the wounds ≤5 cm2 healed, and 90% of wounds ≤6 months in

Discussion

We developed several models of varying complexity that can be used to predict the probability that a venous leg ulcer will heal in a timely fashion using a limb compression bandage. Our results indicated that the likelihood that a venous leg ulcer will heal can be estimated simply by asking about the age of the wound and measuring its area at a patient’s initial evaluation. Although previous studies have evaluated prognostic factors associated with the healing of venous leg ulcers 24, 33, 34, 35

Acknowledgements

The authors would like to thank Daniel Mines, MD, MSCE, James Lewis, MD, MSCE, and Fay Wright, MD, for their critical review of this manuscript; and Ms. S. Masiak and Ms. A. Nesmith for their technical support.

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    Supported in part by a Career Development award from the Dermatology Foundation and Grant AG 00715 from the National Institutes of Health.

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