Healing rates and cost efficacy of outpatient compression treatment for leg ulcers associated with venous insufficiency.
OBJECTIVE
Although newer techniques to promote the healing of leg ulcers associated with chronic venous insufficiency are promising, improved healing rates and cost effectiveness are unproven. We prospectively followed a series of patients who underwent treatment with outpatient compression for venous stasis ulcers without adjuvant techniques to determine healing rates and costs of treatment.


METHODS
Two hundred fifty-two patients with clinical or duplex scan evidence of chronic venous insufficiency and active leg ulcers underwent treatment with ambulatory compression techniques. The patients were prospectively followed with wound measurements at 1-week to 2-week intervals, and the factors that were associated with delayed healing were determined.


RESULTS
Of all the ulcers, 57% were healed at 10 weeks of treatment and 75% were healed at 16 weeks. Ultimately, 96% of the ulcers healed, and only 1 major amputation was necessitated (0.4%). Initial ulcer size and moderate arterial insufficiency (ankle brachial index, 0.5 to 0.8; n = 34) were factors that were independently associated with delayed healing (P <.01). Patient age, ulcer duration before treatment, and morbid obesity did not significantly affect healing times. The cost of 10 weeks of outpatient treatment with compression techniques ranged from $1444 to $2711.


CONCLUSIONS
The treatment of venous stasis ulcers with compression techniques results in reliable, cost-effective healing in most patients. Current adjuvant techniques may prove to be useful but are likely to be cost effective only in a minority of cases, particularly in patients with large initial ulcer size or arterial insufficiency.
Marston
W A
WA
Department of Surgery, University of North Carolina at Chapel Hill School of Medicine, 27599-7210, USA.
Carlin
R E
RE
Passman
M A
MA
Farber
M A
MA
Keagy
B A
BA
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics; D000671:Amputation, Surgical; D000842:Ankle / Q000098:blood supply; D001458:Bandages / Q000191:economics; D001916:Brachial Artery / Q000502:physiology; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D007511:Ischemia / Q000150:complications; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology; D015203:Reproducibility of Results; D018616:Ultrasonography, Doppler, Duplex; D014647:Varicose Ulcer / Q000473:pathology / Q000628:therapy*; D014689:Venous Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D014945:Wound Healing