Risk factors for healing and recurrence of chronic venous leg ulcers

Objective: To identify independent risk factors for delayed healing and inc reased recurrence of chronic venous leg ulcers. Design: Prospective study. Setting: Community-based leg ulcer service. Patients: Six hundred and thirty-three limbs in 587 consecutive patients wi th an ankle-brachial pressure index (ABPI) greater than or equal to 0.85. Method: Potential risk factors were initially assessed in a one-stop clinic incorporating clinical evaluation, ABPI and venous duplex imaging. Limbs w ere treated within a defined protocol. Twenty-four-week healing and 3-year ulcer recurrence rates were determined. Results: Of 12 potential risk factors age (p<0.001), ulcer chronicity (p<0. 001) and popliteal vein reflux (p<0.005) were independent risks for delayed healing. Of 13 potential risk factors rheumatoid arthritis (p<0.005) and h ealing time (p<0.05) were independent risks for ulcer recurrence. Isolated superficial venous reflux treated by saphenous vein surgery predicted reduc ed ulcer recurrence (p<0.005). Conclusion: Targeting in primary care of ulcer patients with specific chara cteristics might encourage earlier referral and appropriate resource manage ment. Leg ulcer patients with superficial venous reflux might benefit from surgical correction.