title: Critical Evaluation of Delayed Healing of Venous Leg Ulcers: A Retrospective Analysis in Canadian Patients.
abstract: BACKGROUND
  Venous leg ulcers (VLUs) are common but challenging health problems. Better understanding of the risk factors involved in delayed healing of VLUs may therefore guide individualized treatment plans to improve patient outcomes.
  
  
  OBJECTIVE
  We sought to identify the risk factors associated with delayed healing of VLUs in patients seen at a tertiary academic wound care clinic.
  
  
  METHODS
  A retrospective analysis of 554 patients who presented to the Toronto Regional Wound Healing Clinic for VLUs in a 3-year period was performed. Patient and ulcer characteristics were recorded. Multivariate analyses were performed to compare patients with ulcer resolution and those whose ulcers did not resolve after 12-month follow-up.
  
  
  RESULTS
  The average age of the patients was 67.3 ± 0.7 years, with 56 % being female. The most common comorbidities were hypertension (54 %), dyslipidemia (33 %), a history of smoking (30 %), and diabetes (26 %). Ulcer resolution was associated with a smaller ulcer size (odds ratio [OR] 0.984 [95 % confidence interval (CI) 0.973, 0.996]), shorter ulcer duration (OR 0.704 [95 % CI 0.574, 0.865]), and dyslipidemia (OR 1.848 [95 % CI 1.052, 3.246]).
  
  
  CONCLUSIONS
  Pro-healing factors associated with VLUs were a smaller ulcer size and a shorter ulcer duration. Dyslipidemia was also associated with improved healing, potentially owing to the use of statins. Patients presenting with poorer-prognosis VLUs should receive more aggressive treatment with earlier referral to vascular surgery.
authors.affiliation: Division of Vascular Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Gary K
authors.initials: GK
authors.lastname: Yang
authors.affiliation: Division of Dermatology, Department of Medicine, Women's College Hospital, University of Toronto, 5th Floor, 76 Grenville Street, Toronto, ON, M5S1B2, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Cao
authors.affiliation: Division of Vascular Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Kayssi
authors.affiliation: Division of Vascular Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Dueck
authors.affiliation: Division of Dermatology, Department of Medicine, Women's College Hospital, University of Toronto, 5th Floor, 76 Grenville Street, Toronto, ON, M5S1B2, Canada. afsaneh.alavi@mail.utoronto.ca.
authors.forename: Afsaneh
authors.initials: A
authors.lastname: Alavi
mesh_terms: D000368:Aged; D002170:Canada; D015897:Comorbidity; D050171:Dyslipidemias / Q000150:complications* / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D014647:Varicose Ulcer / Q000473:pathology / Q000628:therapy*; D014945:Wound Healing / Q000502:physiology*
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors