Healing rates and cost efficacy of outpatient compression treatment for leg ulcers associated with venous insufficiency

Objective: Although newer techniques to promote the healing of leg ulcers a ssociated with chronic venous insufficiency are promising, improved healing rates and cost effectiveness are unproven. We prospectively followed a ser ies of patients who underwent treatment with outpatient compression for ven ous stasis ulcers without adjuvant techniques to determine healing rates an d costs of treatment. Methods: Two hundred fifty-two patients with clinical or duplex scan eviden ce of chronic venous insufficiency and active leg ulcers underwent treatmen t with ambulatory compression techniques. The patients were prospectively f ollowed with wound measurements at 1-week to 2-week intervals, and the fact ors that were associated with delayed healing were determined. Results: Of all the ulcers, 57% were healed at 10 weeks of treatment and 75 % were healed at 16 weeks. Ultimately, 96% of the ulcers healed, and only 1 major amputation was necessitated (0.4%). Initial ulcer size and moderate arterial insufficiency (ankle brachial index, 0.5 to 0.8; n = 34) were fact ors that were independently associated with delayed healing (P <.01). Patie nt age, ulcer duration before treatment, and morbid obesity did not signifi cantly affect healing times. The cost of 10 weeks of outpatient treatment w ith compression techniques ranged from $1444 to $2711. Conclusion: The treatment of venous stasis ulcers with compression techniqu es results in reliable, cost-effective healing in most patients. Current ad juvant techniques may prove to be useful but are likely to be cost effectiv e only in a minority of cases, particularly in patients with large initial ulcer size or arterial insufficiency.