Critical Evaluation of Delayed Healing of Venous Leg Ulcers: A Retrospective Analysis in Canadian Patients.

Abstract

Venous leg ulcers (VLUs) are common but challenging health problems. Better understanding of the risk factors involved in delayed healing of VLUs may therefore guide individualized treatment plans to improve patient outcomes. We sought to identify the risk factors associated with delayed healing of VLUs in patients seen at a tertiary academic wound care clinic. A retrospective analysis of 554 patients who presented to the Toronto Regional Wound Healing Clinic for VLUs in a 3-year period was performed. Patient and ulcer characteristics were recorded. Multivariate analyses were performed to compare patients with ulcer resolution and those whose ulcers did not resolve after 12-month follow-up. The average age of the patients was 67.3 ± 0.7 years, with 56% being female. The most common comorbidities were hypertension (54%), dyslipidemia (33%), a history of smoking (30%), and diabetes (26%). Ulcer resolution was associated with a smaller ulcer size (odds ratio [OR] 0.984 [95% confidence interval (CI) 0.973, 0.996]), shorter ulcer duration (OR 0.704 [95%CI 0.574, 0.865]), and dyslipidemia (OR 1.848 [95%CI 1.052, 3.246]). Pro-healing factors associated with VLUs were a smaller ulcer size and a shorter ulcer duration. Dyslipidemia was also associated with improved healing, potentially owing to the use of statins. Patients presenting with poorer-prognosis VLUs should receive more aggressive treatment with earlier referral to vascular surgery.