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David J. Margolis, MD; Jesse A. Berlin, ScD; Brian L. Strom, MD, MPH

Arch Dermatol. 1999;135:920-926.

Background  Venous leg ulcers afflict a significant portion of the population. The most popular form of therapy for venous leg ulcers is a compression bandage (eg, Unna boot), a therapy that is frequently unsuccessful.

Objective  To describe risk factors associated with the failure of a wound to heal when treated with a limb-compression bandage for 24 weeks.

Design  A retrospective cohort study.

Setting  Single-center outpatient specialty clinic at an academic medical center.

Participants  Two hundred sixty consecutive patients with chronic venous leg ulcers.

Main Outcome Measure  The magnitude of the effect of a given risk factor on the probability that a wound will heal within 24 weeks of care.

Results  Based on an assessment of leg wounds during initial office visits, we observed that the failure of a wound to heal within 24 weeks was significantly associated with larger wound area, measured in square centimeters (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.11-1.27), duration of the wound in months (OR, 1.09; 95% CI, 1.04-1.16), history of venous ligation or venous stripping (OR, 4.58; 95% CI, 1.84-11.36), history of hip or knee replacement surgery (OR, 3.52; 95% CI, 1.12-11.08), ankle brachial index of less than 0.80 (OR, 3.52; 95% CI, 1.12-11.08), and the presence of fibrin on more than 50% of the wound surface (OR, 3.42; 95% CI, 1.38-8.45).

Conclusions  Several risk factors are associated with the failure of a patient's venous leg ulcer to heal while using limb-compression therapy. It is prudent to consider these factors when referring a patient to a wound care subspecialists or for alternative therapies.

From the Departments of Dermatology and Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia.

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