Healing Potential of Lower-Extremity Ulcers in Patients with Arterial Insufficiency with and without Revascularization
Introduction: Patients with arterial insufficiency (Al) are often considered poor candidates for healing leg ulcers. There is no baseline for physicians to utilize when treating patients with Al and leg ulcers. This is the first stage of a multi-stage retrospective study examining patient outcomes in a clinical setting presenting with Al and leg ulcers from 1997 to 2002. Methods: To be included in this study, only patients with ankle/brachial indices less than 0.80 or toe pressure less than 50mmHg were included. The authors reviewed 93 cases, documented their outcomes, and recorded revascularizations, amputations, and current status. Results: The average age of the patients in this study was 72.4±13.7 with an average ulcer size of 11.0cm2±21.4cm22. Among the 93 cases, 33 had revascularizations (35%) and there were 14 major amputations (above or below knee) (15%). Final outcome results included 47 healed (51%), 15 still progressing (16%), 14 lost to follow-up (15%), 14 with major amputations (15%), and 3 deceased (3%). Conclusion: The above data suggests that patients with Al and uncomplicated wounds can often heal their wounds with standard wound care techniques. The use of revascularization in selected cases resulted in a low incidence of major amputation. Primary amputation is, therefore, not the preferred treatment for this group of patients.
McCulloch, SV; Marston, WA; Farber, MA; Fulton, JJ; Keagy, BA
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