[Recurrence rates of venous leg ulcers and the special importance of its surgical treatment].
BACKGROUND
Venous insufficiency may lead to recurrent leg ulcers. The reason for this observation remains still unclear. In this study we tried to underline the influence of surgical treatment on recurrence rate of venous leg ulcers.


METHODS
In this study 69 patients were treated in a special wound care centre. Before treatment the angiological status was evaluated using phlebography or duplex scan. Afterwards, patients were scored according to the "Venous Clinical Severity Score" of the American Venous Forum. During the observation period compression therapy was performed and wounds were treated with moist dressings. Necroses were removed by radical debridement and large ulcers were covered by mesh graft tissue transfer. When indicated incompetent veins were treated surgically.


RESULTS
The follow-up revealed an overall recurrence rate of 21 % after 30 months. Ulcers treated by radical wound debridement or mesh graft tissue transfer demonstrated a significant lower recurrence rate (p = 0.02 and p = 0.03). According to duplex sonography a correlation was evident among severity of venous insufficiency, the "clinical scoring" (p = 0.04), and the recurrence rate (p = 0.023). After surgical intervention by venous stripping, the insufficiency was improved but the recurrence rate was comparable to that of patients treated without venous surgery (p = 0.44).


CONCLUSIONS
Surgical treatment of venous leg ulcers in modern wound care centres can reduce its recurrence rates. Herein this study a correlation among venous insufficiency evidenced by duplex scan and recurrence rate for leg ulcers could be demonstrated.
Werdin
F
F
Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, Berufsgenossenschaftliche Unfallklinik, Universität Tübingen. fwerdin@gmx.de
Sinis
N
N
Schaller
H-E
HE
Coerper
S
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001458:Bandages; D003627:Data Interpretation, Statistical; D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010690:Phlebography; D012008:Recurrence; D012720:Severity of Illness Index; D013526:Surgical Mesh; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014647:Varicose Ulcer / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy; D014689:Venous Insufficiency / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery