title: Prevalence of immune disease in patients with wounds presenting to a tertiary wound healing centre.
abstract: Chronic leg ulcers are a significant cause of morbidity and mortality and account for considerable healthcare and socioeconomic costs. Leg ulcers are a recognised complication of immune disease, and the purpose of this study was to establish the prevalence of immune disease in a cohort of patients with chronic wounds, and to compare wound outcomes in the subjects with and without immune disease. Retrospective chart review was completed on consecutive patients scheduled with the plastic surgeon in the Georgetown University Center for Wound Healing between 1 January 2009 and 31 March 2009. Of the 520 patients scheduled for appointments, 340 were eligible for inclusion. The prevalence of immune disease was higher than expected with 78 of 340 patients (23%) having associated immune disease. At presentation, wounds in patients with immune disease had a significantly larger mean surface area [33·4 cm(2)  (69·05) compared to 22·5 cm(2)  (63·65), P = 0·02]. Split thickness skin graft (STSG) and bioengineered alternative tissue (BAT) graft data was available on 177 grafts from 55 subjects. There was a significantly lower response rate to STSG in subjects with immune disease (50% compared to 97%, P = 0·0002), but response rates to BAT were not different. The association between immune diseases and chronic wounds may provide unique insights into pathways of wound healing, and warrants further study.
authors.affiliation: Division of Rheumatology, Immunology and Allergy, Georgetown University Hospital, Washington, DC 20007, USA. vks4@gunet.georgetown.edu
authors.forename: Victoria K
authors.initials: VK
authors.lastname: Shanmugam
authors.forename: Amber
authors.initials: A
authors.lastname: Schilling
authors.forename: Anthony
authors.initials: A
authors.lastname: Germinario
authors.forename: Mihriye
authors.initials: M
authors.lastname: Mete
authors.forename: Paul
authors.initials: P
authors.lastname: Kim
authors.forename: John
authors.initials: J
authors.lastname: Steinberg
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Attinger
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002908:Chronic Disease; D015331:Cohort Studies; D016208:Databases, Factual; D003646:Debridement / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007154:Immune System Diseases / Q000175:diagnosis / Q000453:epidemiology*; D016867:Immunocompromised Host; D007871:Leg Ulcer / Q000453:epidemiology* / Q000276:immunology* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016038:Skin Transplantation / Q000379:methods; D063128:Tertiary Health Care / Q000379:methods; D016896:Treatment Outcome; D014945:Wound Healing / Q000276:immunology* / Q000502:physiology