Venous ulcer healing: effect of socioeconomic factors in London.

OBJECTIVE: To determine which social and clinical factors are associated with healing in patients with venous ulceration. DESIGN: Patients were questioned about social factors at their first visit to a community ulcer clinic. They were treated by high compression bandage system and were interviewed again after 12 weeks. SETTING: Community leg ulcer clinics held in health centres throughout Riverside Health Authority in London. PATIENTS: All patients referred to five community leg ulcer clinics with venous ulceration over a six month period. MAIN OUTCOME MEASURES: These were factors significantly associated with healing within 12 weeks of beginning treatment, measured by odds ratio (OR) given by logistic regression analysis. MAIN RESULTS: Of 168 patients with venous ulceration, 87 (52%) healed after 12 weeks of treatment. Univariate analysis showed that low social class (OR = 3.44, 95% CI 1.17, 10.14), lack of central heating (OR = 2.22, 95% CI 1.18, 4.18), and being single (OR = 2.77, 95% CI 1.15, 6.69) were all significantly associated with delayed healing. After adjustment for the known risk factors of ulcer size, ulcer duration, and general mobility only lack of central heating was still significant (OR = 2.27, 95% CI 1.11, 4.55). The remaining factors failing to achieve statistical significance because of their inter-relationship with the known risk factors. CONCLUSIONS: Clinical features of the ulcer seem to determine the progress of healing in patients with leg ulceration. Although there were associations between socio-economic factors and poor healing, adjustment for clinical risk factors generally led to lower non-significant associations. Only lack of central heating retained its association and may play a part in prolonging healing of venous ulceration.

A trial of a hydrocolloid dressing in the management of indolent ulceration.

A report of a randomised, controlled trial of a hydrocolloid dressing used in the treatment of leg ulcers that were failing to heal.

Assessing a calcium alginate dressing for venous ulcers of the leg.

A small study of Tegagel calcium alginate dressings is described, with a discussion of the methodology employed.

A pioneering service to the community. The Riverside Community Leg Ulcer Project.

1. Leg ulceration is an extensive problem that is often poorly managed. 2. Research-based treatment of leg ulceration results in rapid improvements in healing rates. 3. A systematic, multidisciplinary approach optimises the effectiveness of services. 4. Effective services must be underpinned by comprehensive training programmes.

Risk factors for leg ulcer recurrence: a randomized trial of two types of compression stocking.

Patients with recently healed leg ulceration were entered into a study of leg ulcer recurrence. In all, 188 patients [69% women, mean age = 72 (SD = 12) years] were entered into the study, of whom 166 were considered suitable for ready-made stockings and were randomized to one of two class II below-knee compression stockings and followed for at least 18 months. The remaining patients required either made-to-measure stockings (5) or could not tolerate stockings owing to friable skin and were treated by other methods (17). Overall cumulative recurrence rate was 26% after 1 year and 31% at 18 months. Independent risk factors for (RR = 2.34, p = 0.021) and unsuitability for stockings (RR = 2.52, p = 0.013). The randomized groups had similar stockings, 25 (15%) could not put their stockings on at all and 43 (26%) were only able to put them on with great difficulty. The two stocking types differed significantly in this regard when analysed for trend.

Factors associated with healing leg ulceration with high compression.

To investigate factors relevant to the healing of leg ulceration by high compression, patients were interviewed using a standard questionnaire prior to treatment with a four-layer bandage high-compression system in six community ulcer clinics. We explored the relation of size, ulcer duration and medical history to healing. Cumulative healing rates were high using this method, being 69% after 12 weeks and 83% after 24 weeks. Twelve-week healing rates varied slightly between clinics, ranging from 62% to 83%. Univariate analysis of the total group showed that male sex (RR = 0.77, p = 0.023), poor limb joint mobility (RR = 0.39, p < 0.001), poor general mobility (RR = 0.49, p = 0.015), treatment at home (RR = 0.52, p < 0.001), ulcer size > 10 cm2 (RR = 0.37, p < 0.001), history of deep vein thrombosis (RR = 0.67, p = 0.016) and ulcer duration >6 months (RR = 0.35, p < 0.001) were significantly inversely associated with healing, Ulcer size, duration, limb joint mobility and general mobility were significant independent factors in multivariate analysis.