ABSTRACT
OBJECTIVE: To determine the quality of venous leg ulcer care given in a multidisciplinary, specialist wound-healing centre and to identify problem areas that might affect it. METHOD: The case records of 90 consecutive patients with venous leg ulcers, diagnosed and treated at the Copenhagen Wound Healing Centre, Denmark, were retrospectively audited by a Scandinavian cross-sectional and multidisciplinary expert panel. Quality of care was audited in each case using implicit criteria. The experts then formulated key recommendations for good clinical practice for patients with venous leg ulcers. RESULTS: Quality of care was satisfactory in 74 patients (82%). The one-year healing rate was 77% (69/90), with a three-month recurrence rate of 12% (11/90). Identified problem areas included the lack of systematic assessment of patients' suitability for surgery; lack of systematic, duplex-verified diagnoses of venous aetiology; and the lack of systematic examination of distal arterial pressure. The recommendations include the need for venous diagnosis, differential diagnosis, compression therapy, surgery, systemic treatment, access to venous leg ulcer care and better communication. CONCLUSION: The quality of venous leg ulcer care given in this multidisciplinary centre was satisfactory.
Subject(s)
Ambulatory Care Facilities/standards , Patient Care Team/standards , Quality of Health Care , Varicose Ulcer/therapy , Adult , Denmark , Humans , Medical Audit , Practice Guidelines as Topic , Retrospective Studies , Varicose Ulcer/diagnosis , Wound HealingABSTRACT
AIMS: this study aimed to investigate the influence of venous insufficiency on results in venous leg ulcers treated with ulcer excision, meshed split-skin transplantation and correction of superficial venous insufficiency in the wound area. DESIGN: retrospective cohort study. SETTING: Copenhagen Wound Healing Center. METHODS: in 113 patients with venous leg ulceration, examined preoperatively with colour Duplex scanning (CDS), prognostic factors of healing and recurrence within 1 year were analysed using logistic regression. RESULTS: cumulative 1-year healing rate was 65% (73 patients) and 13 (12%) had recurrence of ulceration 1 year postoperatively. Initial ulcer size (OR: 0.97(95% CI: 0.96-0.99)), minor local superficial venous surgery (OR: 2.38 (95% CI: 1.04-5.46)), sufficient popliteal vein (2.97 (1.05-8.42)) and non-compliance with compression therapy (OR: 0.27 (95% CI: 0.11-0.71)) influenced the prognosis of healing positively. No statistically significant differences in healing and recurrence between patients with isolated superficial and mixed superficial/deep venous insufficiency was found. CONCLUSION: non-healing venous leg ulcers can be treated with ulcer excision, meshed split-skin transplantation and correction of superficial venous insufficiency in the wound area with beneficial results irrespective of underlying pattern of venous insufficiency as determined by CDS.
