title: Significance of limb trauma as an initiating factor in chronic leg ulceration.
abstract: OBJECTIVE
  To assess differences in clinical outcomes between patients with traumatic and spontaneous leg ulcers.
  
  
  METHODS
  Consecutive leg ulcer follow-up patients seen between April 2004 and October 2005 in a specialist leg ulcer clinic were asked about the mechanism of the original ulceration. Twenty-four-week healing and 12-month recurrence rates were calculated using Kaplan-Meier analysis and outcomes were compared between groups with traumatic and spontaneous ulcers.
  
  
  RESULTS
  Of the 300 patients assessed, 38 were excluded (incomplete data). In the remaining 262 patients, cause of ulceration was traumatic in 116/262 (44%) and spontaneous in 146/262 (56%). Age, ankle brachial pressure index <0.85 and venous reflux were equally distributed between groups with traumatic and spontaneous ulcers (P = 0.470, 0.793, 0.965 respectively, Chi-square test). Twenty-four-week healing rates were 81% for traumatic and 67% for spontaneous ulcers (P = 0.015, Log-Rank test). Twelve-month recurrence rates were 32% for traumatic and 33% for spontaneous ulcers (P = 0.970, Log-rank test). Patients with traumatic ulcers suffered a total of 53 ulcer recurrences (median 0, range 0-4) compared with 89 in patients with spontaneous ulcers (median 0, range 0-8) (P < 0.001, Mann-Whitney U test).
  
  
  CONCLUSIONS
  Approximately half of all leg ulcer patients recall a traumatic event. When managed in leg ulcer clinic, traumatic ulcers heal faster and recur less frequently than spontaneous ulcers.
authors.affiliation: Department of Vascular Surgery, Cheltenham General Hospital, Sandford Road, Cheltenham, Gloucestershire GL53 7AN, UK.
authors.forename: S R
authors.initials: SR
authors.lastname: Kulkarni
authors.forename: M S
authors.initials: MS
authors.lastname: Gohel
authors.forename: M R
authors.initials: MR
authors.lastname: Whyman
authors.forename: K R
authors.initials: KR
authors.lastname: Poskitt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007869:Leg Injuries / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology*; D007871:Leg Ulcer / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D014945:Wound Healing