Downloaded from http://journals.lww.com/jwocnonline by BhDMf5ePHKbH4TTImqenVBK1ADxQ4bnr9hYEMWfLWlRgdauEZMT85Ib+FBMrnT272HbOyU915NE= on 10/11/2020 Copyright © 2020 Wound, Ostomy and Continence Nurses Society™. Unauthorized reproduction of this article is prohibited. Copyright © 2020 by the Wound, Ostomy and Continence Nurses Society™ JWOCN ¿ September/October 2020 477 J Wound Ostomy Continence Nurs. 2020;47(5):477-483. Published by Lippincott Williams & Wilkins Wound Care ABSTRACT PURPOSE: The purpose of this study was to explore average time to heal for patients with venous leg ulcers (VLUs) receiving standard of care that included compression and advanced wound dressings. DESIGN: Secondary analysis of an existing electronic database. SUBJECT AND SETTINGS: A convenience sample consisting of 1323 patients with VLUs from various community care sectors (homecare and clinics) across Canada. METHODS: The Wound Studies database used in the analysis consisted of data from 6 studies conducted prospectively between 1999 and 2009 in which the treatment and delivery of care for all lower leg ulcers (venous, arterial, and mixed) in Canada was examined. From these studies, only patients with VLUs, with an ankle-brachial pressure index of greater than 0.8, and surface area measurements of the ulcers at baseline, 3 months, and 6 months were included. Descriptive statistics were used to determine the proportion of patients who achieved closure at 3 and 6 months and explore the weekly and monthly healing rates for those who did and did not achieve closure. Logistic regression analysis was performed to identify predictive factors for healing. RESULTS: A total of 777 patients (mean age 69 years) met inclusion criteria. The proportion of patients who achieved closure at 3 and 6 months was 42.2% and 48.6%, respectively. Of the participants who achieved wound closure, monthly mean healing rate, measured by percentage of reduction in surface area, was 33.4% (0.56 cm 2 , SD 1.4 [median 0.15 cm 2 ]) through month 3, and 31.0% (0.70 cm 2 , SD 1.6 [median 0.08 cm 2 ]) through month 6. The overall monthly surface area reduction was 30%. CONCLUSION: Study findings suggest a monthly surface area reduction of 30% provides a baseline healing rate for VLUs managed with compression therapy and advanced dressings. Findings also suggest standard of care is not sufficient for healing in over 50% of the population, as the proportion of those who achieved closure at 3 and 6 months was 42.2% and 48.6%, respectively. KEY WORDS: Compression, Healing rate, Lower leg ulcer, Venous leg ulcer, Wound closure, Wound healing. INTRODUCTION Venous leg ulcers (VLUs) account for an estimated 70% of all lower leg ulcers 1 and occur in 1% to 3% of the popula- tion worldwide. 2 A systematic review of 8 prevalence studies reporting clinical validation of open or healed VLUs, from var- ious countries, reported an estimated overall prevalence rate of 0.12% to 1.8%. 3 One Canadian study identifed a leg ulcer prevalence rate of 0.18% 4 confrming the prevalence for VLUs in Canada is consistent with the global average. Based on 2018 census reporting, this equates to approximately 45,360 Canadians. 5 Venous leg ulcers can negatively impact quality of life (QoL) in every facet of the biopsychosocial spectrum. For example, a study conducted by Marin and Woo 6 reported 15.1% of people with a VLU experience rest/night pain. Other health-related issues include sleep disturbance, depression, re- duced mobility, and social isolation, the later often a result of one’s inability to maintain his or her professional lifestyle. 2,6 Venous disease of the legs is complex and often multifac- torial. Chronic venous hypertension is the hallmark of the disease, with common pathological etiologies including (1) incompetent valves as a result of injury, recurring phlebitis, or chronic edema/venous distention often associated with chron- ic heart failure, hepatic disease, and nephropathy; (2) venous obstruction related to externally applied pressure such as with obesity and tumors; and/or (3) inefective calf muscle pump failure that results in insufcient pressure during muscle con- tractions to return blood up out of the lower leg. Older people are more likely to develop calf muscle failure compared with younger individuals due to muscle wasting, neuropathy, im- mobility, and/or limited ankle mobility. Chronic venous in- sufciency is a leading cause of VLUs, reported to afect more females (25%-40%) than males (10%-20%) 7 ; however, the sex diference in leg ulcer prevalence dissipates with age. 8 Erin M. Rajhathy, RN, BScN, MClSc, NSWOC, WOCC(C), South East Local Health Integration Network, Kingston, Ontario, Canada. Heather D. Murray, RN, BScN, MClSc, NSWOC, London Health Science Center, London, Ontario, Canada. Veronica A. Roberge, RN, BScN, MClSc, NSWOC, Castlegar, British Columbia, Canada. Kevin Y. Woo, PhD, RN, NSWOC, WOCC(C), FAPWCA, Faculty of Nursing, Queens University, Kingston, Ontario, Canada. The authors declare no conflicts of interest. Correspondence: Erin M. Rajhathy, RN, BScN, MClSc, NSWOC, WOCC(C), South East LHIN, 1471 John Counter Blvd, Kingston, ON K7M 8S8, Canada (Erin.Rajhathy@lhins.on.ca). Healing Rates of Venous Leg Ulcers Managed With Compression Therapy A Secondary Analysis of Data Erin M. Rajhathy ¿ Heather D. Murray ¿ Veronica A. Roberge ¿ Kevin Y. Woo DOI: 10.1097/WON.0000000000000693