HEALING OF VENOUS ULCERS IN AN AMBULATORY CARE PROGRAM - THE ROLES OF CHRONIC VENOUS INSUFFICIENCY AND PATIENT COMPLIANCE

Purpose: A nurse-managed/physician-supervised treatment program for venous ulceration was evaluated to determine the influence of Venous hemodynamics, comorbidities, patient behavior, and ulcer characteristics on time to healing and time to recurrence. Methods: The clinical course and long-term follow-up of 71 patients with 99 venous ulcers diagnosed between November 1981 and August 1994 were analyzed by a retrospective review of clinic records. Demographic data, severity of venous insufficiency, ulcer characteristics, and patient compliance were studied. Outcome variables were time to complete ulcer healing and time to first recurrence. Results: Ninety-one percent of the ulcers healed completely at a median 3.4 months. There were 52 (57%) recurrences at a median 10.4 months. Ulcers on Limbs with a venous refill time of 10 seconds or less demonstrated a significantly longer time to complete healing (p less than or equal to 0.03); however, no effect on time to recurrence was observed. Patients who were in strict compliance with the treatment regimen (n = 32) had significantly faster healing (p less than or equal to 0.02) and fewer recurrences (p less than or equal to 0.004) compared with patients who were less compliant (n = 67). Conclusions: Most venous ulcers can be expected to heal when patients are enrolled in a nurse-managed/physician-supervised ambulatory ulcer clinic. Photoplethysmography-derived venous refill time of 10 seconds or less predicted delayed healing. Strict compliance with the treatment protocol significantly decreased the time to healing and prolonged the time to recurrence.