The Frustrating 15: What’s Missing?
March 17, 2008 | Leave a Comment
Dot Weir, RN, CWON, CWS
Caroline Fifes’s commentary on the state of healing of venous leg ulcers over the years evoked several questions. She described the “frustrating 15%,” describing the relatively small change in healing rates of this population of patients through the years. This begs the question, how can this be? Our diagnostic skills regarding recognition of atypical ulcers that masquerade as venous ulcers have improved and we have many more advanced and “active” topical approaches in our treatment armamentarium. As Caroline more than adequately noted, wound care professionals know and understand the necessity of adequate compression and many sophisticated options for providing that compression are available.
What is missing in the care of that frustrating population (the 15%) of refractory ulcers? Although the following ideas might not change outcome statistics, at least five factors must be understood in order to impact refractory ulcerations:
1. Patient participation
2. Recognition of the impact of bacteria
3. Recognition of atypical ulcers
4. Use of advanced treatments
5. Defining closure versus healing.
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Bringing Wound Care Back To The Future
March 17, 2008 | Leave a Comment
A 20-year perspective on Venous Ulcer management
Caroline Fife, MD
The majority of patients afflicted with chronic wounds suffer from lower extremity ulcers caused by chronic venous insufficiency (CVI) that affects approximately 2.5 million people in the US. It has been estimated that approximately 600,000 people seek treatment for venous leg ulcers on an annual basis and given the relationship between age and venous ulceration that number most likely will continue to grow as the population ages. Tremendous effort has been expended by many organizations to define the standard of care for venous ulcerations.
Data show that following guidelines improves patient outcomes. With regard to venous ulceration, guidelines are focused on the provision of appropriate compression. Margolis1,2 reported that appropriate limb compression resulted in healing rates of 30% to 60% at 24 weeks and 70% to 85% at 1 year. In a 2006 study of wound healing trajectories in 232 patients conducted in eight trials over 10 years, Steed3 showed that 60% of patients were healed on average at 20 weeks. Thus, when appropriate compression is applied, the overall healing rate in venous ulcers approaches 80% and has remained unchanged for the past 20 years.
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