Title: Initial healing rates of venous ulcers: are they useful as predictors of healing?
Authors: M.C. Robson, M.D., D.P. Hill, PharmD, S. Poore, R.G.N., J. Wilson, R.G.N.
Source: The American Journal of Surgery , Volume 188, Number 1A, pp. 22-25
PODIATRIC RELEVANCE:
Studying healing rates of venous ulcers will help us determine the therapeutic responses in deciding if a particular therapeutic approach should be continued. The new technologies that are being produced from the biotechnology companies are creating alternative methods of treating chronic wounds. The time it takes to heal a venous leg ulcer is an important factor in treating wounds. Wound care is time consuming as well as costly. Wound therapy treatments currently on the market directly affect the way we as podiatrists can treat chronic nature ulcers. It is important to also understand that venous leg ulcers require a lengthy healing process. Therefore, it is important to compare healing rates in venous leg ulcers to see if the current wound care products on the market are efficacious.
METHODS:
This study is a retrospective analysis of data that came from patients with venous leg ulcers enrolled in a randomized, placebo-controlled clinical trial of a wound care product called Prezatide copper acetate gel (PCA). A total of 18 patients with 27 venous leg ulcers were analyzed. Venous ulcers were measured weekly for up to 12 weeks whereas healing states were determined for up to 24 weeks. Initial healing rates were calculated by Margolis and later modified by Tallman, also known as the 2 methods. The initial healing rates calculated by Margolis have taken both wound area and perimeter into account. Eighteen patients were randomized to receive 1 of 2 doses of PCA gel or no gel. Patients from both groups were combined for the final analysis. All patients have undergone compression therapy after the gel was applied. Photocopies of the original wound measurements were scanned and analyzed to determine both the wound area and perimeter over the course of the study. Later on, the predicted time to healing a wound completely was determined by the estimated wound radius and the initial healing rate, known as the Tallman method.
RESULTS:
Sufficient data was only available from 17 patients; 1 patient was excluded secondary to a lack of wound tracings. The study included 7 men and 10 women with a mean average of 71 years of age. Initial ulcers had a median area of 10.4 square centimeters. The duration of ulcers ranged from 3-48 months with a median of 7 months. Two patients have healed completely within 12 weeks and 5 patients have healed within 24 weeks. Out of these 5 patients, only 4 have received PCA. The initial healing rates that were calculated by the 2 methods were arranged together to determine their predictive ability in all 17 patients. Of the 17 patients, 10 were predicted to not heal within 24 weeks and 7 were predicted to heal within 24 weeks. In actuality, out of the 7 patients that were predicted to heal within 24 weeks, only 4 healed and out of the 10 patients predicted not to heal within 24 weeks, only 9 were not healed with 1 patient healing at 14 weeks. 59% of the ulcers had an increase above their baseline size within the first 4 weeks of therapy. However, the 2 methods for calculating initial healing rates have not differed much according to this study.
COMMENTS:
Patients with peripheral vascular disease and edema are at higher risk for developing venous ulcers. Patients with venous leg ulcers exhibit a variation in the duration of healing. The healing curves seen by comparing acute wounds and venous leg ulcers do show variance secondary to the poor predictive performance in patients with venous ulcers. The concept of healing charts and trajectories remains an important part of future wound therapy treatment and research. Predictive success for an acute traumatic wound depends on the wound’s stability, which isn’t observed in venous ulcers. To conclude, in this study, the mean initial healing rate was greater for those patients that have healed their venous ulcers, suggesting that the rates have some predictive or comparative usefulness.
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Disclaimer:
Scientific Abstract Monthly postings are submitted by podiatric surgical residents. The ideas presented are not the opinions of the American College of Foot and Ankle Surgeons (ACFAS), nor are they presented as facts. ACFAS presents this information without any warranty of any kind, expressed or implied, and is not liable for its accuracy nor for any loss or damage caused by the user's reliance on information obtained in these areas.