HEALING OF VENOUS ULCERS IN AN AMBULATORY CARE PROGRAM - THE ROLES OFCHRONIC VENOUS INSUFFICIENCY AND PATIENT COMPLIANCE

Purpose: A nurse-managed/physician-supervised treatment program for ve nous ulceration was evaluated to determine the influence of Venous hem odynamics, comorbidities, patient behavior, and ulcer characteristics on time to healing and time to recurrence. Methods: The clinical cours e and long-term follow-up of 71 patients with 99 venous ulcers diagnos ed between November 1981 and August 1994 were analyzed by a retrospect ive review of clinic records. Demographic data, severity of venous ins ufficiency, ulcer characteristics, and patient compliance were studied . Outcome variables were time to complete ulcer healing and time to fi rst recurrence. Results: Ninety-one percent of the ulcers healed compl etely at a median 3.4 months. There were 52 (57%) recurrences at a med ian 10.4 months. Ulcers on Limbs with a venous refill time of 10 secon ds or less demonstrated a significantly longer time to complete healin g (p less than or equal to 0.03); however, no effect on time to recurr ence was observed. Patients who were in strict compliance with the tre atment regimen (n = 32) had significantly faster healing (p less than or equal to 0.02) and fewer recurrences (p less than or equal to 0.004 ) compared with patients who were less compliant (n = 67). Conclusions : Most venous ulcers can be expected to heal when patients are enrolle d in a nurse-managed/physician-supervised ambulatory ulcer clinic. Pho toplethysmography-derived venous refill time of 10 seconds or less pre dicted delayed healing. Strict compliance with the treatment protocol significantly decreased the time to healing and prolonged the time to recurrence.