The influence of polymorbidity, revascularization, and wound therapy on the healing of arterial ulceration.
OBJECTIVE
An ulcer categorized as Fontaine's stage IV represents a chronic wound, risk factor of arteriosclerosis, and co-morbidities which disturb wound healing. Our objective was to analyze wound healing and to assess potential factors affecting the healing process.


METHODS
199 patients were included in this 5-year study. The significance levels were determined by chi-squared and log-rank tests. The calculation of patency rate followed the Kaplan-Meier method.


RESULTS
Mean age and co-morbidities did not differ from those in current epidemiological studies. Of the patients with ulcer latency of more than 13 weeks (up to one year), 40% required vascular surgery. Vascular surgery was not possible for 53 patients and they were treated conservatively. The amputation rate in the conservatively treated group was 37%, whereas in the revascularizated group it was only 16%. Ulcers in patients with revascularization healed in 92% of cases after 24 weeks. In contrast, we found a healing rate of only 40% in the conservatively treated group (p<0.001). Revascularization appeared more often in diabetic patients (n=110; p<0.01) and the wound size and number of infections were elevated (p=0.03). Among those treated conservatively, wound healing was decelerated (p=0.01/0.02; chi(2) test).


CONCLUSIONS
The success of revascularization, presence of diabetes mellitus, and wound treatment proved to be prognostic factors for wound healing in arterial ulcers.
Tautenhahn
Joerg
J
Department of General, Visceral and Vascular Surgery, Medical School, Otto-von-Guericke University, Magdeburg, Germany.
Lobmann
Ralf
R
Koenig
Brigitte
B
Halloul
Zuhir
Z
Lippert
Hans
H
Buerger
Thomas
T
D000368:Aged; D001157:Arterial Occlusive Diseases / Q000453:epidemiology*; D003327:Coronary Disease / Q000453:epidemiology; D003925:Diabetic Angiopathies / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007871:Leg Ulcer / Q000188:drug therapy* / Q000453:epidemiology*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000453:epidemiology; D010359:Patient Readmission; D051437:Renal Insufficiency / Q000453:epidemiology; D012907:Smoking / Q000453:epidemiology; D014945:Wound Healing; D014946:Wound Infection / Q000188:drug therapy / Q000601:surgery