Surgical treatment of large vascular leg ulcers: a retrospective review evaluating risk factors for healing and recurrence.

ABSTRACT

BACKGROUND: Superficial reflux ablation and revascularization improve the long-term prognosis of venous and arterial leg ulcers but do not solve the problem of protracted healing of large chronic wounds. Skin grafting has been shown to successfully heal chronic leg ulcers. OBJECTIVE: To identify risk factors for ulcer healing and recurrence after shave therapy and split-skin grafting in patients with large ulcers treated surgically for venous insufficiency. METHODS: Single-center retrospective cohort study involving 72 chronic leg ulcers with a mean area of 77 ± 132 cm. Healing and recurrence rates were determined using life-table analysis. Clinical, demographic, and hemodynamic parameters were correlated with healing and recurrence using Cox regression analysis. RESULTS: Sixty ulcers (83%) healed after a mean of 1.9 months and 15 ulcers (25%) recurred after a mean of 12.7 months. Healing was positively associated with compression treatment (hazard ratio [HR] 2.02, 95% confidence interval [CI] 1.14-3.59) and negatively associated with ulcer duration (HR 0.99, 95% CI 0.98-1.0). Male sex, ulcer duration, and deep venous reflux were identified as significant risk factors for ulcer recurrence (HR 0.14, 95% CI 0.03-0.73; HR 1.02, 95% CI 1.0-1.04; and HR 5.4, 95% CI 1.30-22.31). CONCLUSION: Early surgical intervention improves healing and reduces the risk of ulcer recurrence.