title: Factors associated with poor healing and recurrence of venous ulceration.
abstract: BACKGROUND
  Plastic surgeons are often approached for wound management and closure of chronic venous ulcers that fail to heal despite multimodal management. The authors present a retrospective analysis of a large series of venous ulcers to determine factors predicting nonhealing and recurrence.
  
  
  METHODS
  Consecutive patients with chronic venous ulcers (≥ 2-cm diameter) were examined for the presence of superficial, perforating, or deep venous disease, including reflux and/or obstruction. Treatment included compression, venous ligation, stripping, thermal ablation, sclerotherapy, and local wound care. Ulcers refractory to 6 months of treatment were defined as nonhealing ulcers. Data were analyzed for differences in baseline patient and ulcer characteristics and clinical course of nonhealing ulcers. Data were compared using Wilcoxon rank sum, chi-square, and Fisher's exact tests using Sigma Stat and SPSS, with α set at p < 0.05.
  
  
  RESULTS
  The authors identified 153 ulcers in 127 patients. Factors associated with ulcer nonhealing included advanced age, increased body mass index, history of deep venous thrombosis, noncompliance with compression therapy, and large ulcer area. One hundred thirty-one of the ulcers (85.6 percent) healed within 6 months and 147 (96 percent) of the ulcers ultimately healed without the need for operative plastic surgical intervention.
  
  
  CONCLUSIONS
  A thorough understanding of risks and expected clinical course is required for assessment of the nonhealing venous ulcer. The authors recommend identification and correction of underlying venous abnormality and a minimum of at least 6 months of compression and local wound care followed by reassessment of venous function before operative plastic surgical intervention should be considered.
  
  
  METHODS
  Risk, III.
authors.affiliation: Stony Brook, N.Y. From the Division of Vascular Surgery, the School of Medicine, and the Division of Plastic Surgery, Stony Brook University Medical Center.
authors.forename: Nicos
authors.initials: N
authors.lastname: Labropoulos
authors.forename: Eric D
authors.initials: ED
authors.lastname: Wang
authors.forename: Steven T
authors.initials: ST
authors.lastname: Lanier
authors.forename: Sami U
authors.initials: SU
authors.lastname: Khan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008026:Ligation; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D015911:Sclerotherapy; D017211:Treatment Failure; D018616:Ultrasonography, Doppler, Duplex; D014647:Varicose Ulcer / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D014680:Veins / Q000601:surgery; D014945:Wound Healing / Q000502:physiology