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The influence of polymorbidity, revascularization, and wound therapy on the healing of arterial ulceration

Authors Tautenhahn J, Lobmann R, Koenig B, Halloul Z, Lippert H, Buerger T

Published 6 June 2008 Volume 2008:4(3) Pages 683—689


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Joerg Tautenhahn1, Ralf Lobmann2, Brigitte Koenig3, Zuhir Halloul1, Hans Lippert1, Thomas Buerger1

1Department of General, Visceral and Vascular Surgery; 2Department of Endocrinology and Metabolism; 3Institute for Medical Microbiology, Medical School, Otto-von-Guericke University, Magdeburg, Germany

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; χ² test).

Conclusions: The success of revascularization, presence of diabetes mellitus, and wound treatment proved to be prognostic factors for wound healing in arterial ulcers.

Keywords: arterial leg ulcer, wound management, risk factors, revascularization

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