October 1997

Initial Rate of Healing Predicts Complete Healing of Venous Ulcers

Author Affiliations

From the Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine (Drs Tallman, Eaglstein, and Falanga and Mss Muscare and Carson), and Miami Veterans Affairs Medical Center (Dr Falanga), Miami, Fla. Dr Tallman is presently with the Billings Clinic, Billings, Mont.

Arch Dermatol. 1997;133(10):1231-1234. doi:10.1001/archderm.1997.03890460053006

Background:  Venous ulcers represent a clinical problem with considerable morbidity, especially in the elderly population. Standard treatment is the use of leg compression bandages to improve the underlying venous hypertension, but not every ulcer heals in a timely fashion with this treatment modality. Methods are needed to predict the outcome of standard treatment as soon as possible to institute alternative therapy.

Objective:  To prospectively study the rate of healing in a group of elderly patients with venous ulcers, based on a previously described equation that takes into account the size and perimeter of the ulcer.

Methods:  We studied by computerized planimetry 15 elderly patients with venous ulcers treated with leg compression bandages for up to 24 weeks or until complete healing. We determined weekly healing rate by comparing ulcer size at each visit to initial baseline size (baseline-adjusted healing rate). Also, we used a novel way to calculate the healing rate at a given week by taking the mean of all previous healing rates between each visit (meanadjusted healing rate).

Results:  When using the baseline-adjusted healing rate, we noted what we describe as a healing rate instability from week to week, which decreases the ability to predict complete healing. However, the mean-adjusted healing rate allowed us to predict complete healing as early as 3 weeks from starting therapy (P<.001).

Conclusion:  In this prospective study of elderly patients with venous ulcers, we describe a novel and more powerful method for predicting complete healing of venous ulcers with compression therapy alone.Arch Dermatol. 1997;133:1231-1234