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Risk factors for delayed healing
Venous leg ulcers
Treatment of chronic wounds is a difficult medical challenge that consumes significant healthcare resources. Prognostic indicators for ulcer healing are therefore important in helping to identify potentially slow-healing ulcers which might benefit from advanced treatment options. Several groups have investigated the prognostic factors for venous ulcer healing. A European Wound Management Association (EWMA) position document lists the following risk factors for delayed healing.
- Duration > 6 months
- Ulcer size 10cm2
- Reduced mobility
- Severe pain
- Psychological factors
- Male gender
- Poor general health
Baseline ulcer duration, size and percentage healing at week three can accurately predict delayed healing with standard therapy.
Diabetic foot ulcers
Margolis et al. (2003), have developed a simple prognostic model, assigning points according to duration, size and depth of ulcer, to be used in routine care for risk stratification of patients based on their likelihood of not responding to standard therapy with GWC with wound debridement, moist dressings and offloading techniques. The model, which was derived from a retrospective study of 27,630 patients with diabetic neuropathic ulcers from a wound care database spanning 18 years and encompassing 150 treatment centres, counts 1 point each for wounds over two months old, wounds larger than 2cm2, or grade ≥ 3 on a 6-point scale (penetrating through skin to expose tendon, ligament or joint, or worse). Those wounds displaying none of these factors had a 66% probability of healing by 20 weeks, compared with only 22% for those with all three criteria.
- Duration > 2 months
- Ulcer size 2cm2
- Ulcer grade ≥ 3
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