*Department of Dermatology, Division of General Dermatology, Medical University Vienna, Vienna, Austria; †Private Practice in Dermatology and Angiology, Vienna, Austria.
Dermatol Surg. 2014 Nov;40(11):1240-8. doi: 10.1097/DSS.0000000000000137.
Superficial reflux ablation and revascularization improve the long-term prognosis of venous and arterial leg ulcers but do not solve the problem of protracted healing of large chronic wounds. Skin grafting has been shown to successfully heal chronic leg ulcers.
To identify risk factors for ulcer healing and recurrence after shave therapy and split-skin grafting in patients with large ulcers treated surgically for venous insufficiency.
Single-center retrospective cohort study involving 72 chronic leg ulcers with a mean area of 77 ± 132 cm. Healing and recurrence rates were determined using life-table analysis. Clinical, demographic, and hemodynamic parameters were correlated with healing and recurrence using Cox regression analysis.
Sixty ulcers (83%) healed after a mean of 1.9 months and 15 ulcers (25%) recurred after a mean of 12.7 months. Healing was positively associated with compression treatment (hazard ratio [HR]: 2.02, 95% confidence interval [CI]: 1.14-3.59) and negatively associated with ulcer duration (HR: 0.99, 95% CI: 0.98-1.0). Male sex, ulcer duration, and deep venous reflux were identified as significant risk factors for ulcer recurrence (HR: 0.14, 95% CI: 0.03-0.73; HR: 1.02, 95% CI: 1.0-1.04; and HR: 5.4, 95% CI: 1.30-22.31).
Early surgical intervention improves healing and reduces the risk of ulcer recurrence.
浅表反流消融和再血管化可改善静脉和动脉腿部溃疡的长期预后，但不能解决大型慢性伤口愈合时间长的问题。植皮已被证明可成功治愈慢性腿部溃疡。
确定静脉功能不全患者大型溃疡接受手术治疗后， shave 治疗和游离皮片移植后溃疡愈合和复发的危险因素。
单中心回顾性队列研究，纳入 72 例慢性腿部溃疡患者，平均溃疡面积为 77 ± 132cm²。使用寿命表分析确定愈合和复发率。使用 Cox 回归分析将临床、人口统计学和血流动力学参数与愈合和复发相关联。
60 例溃疡（83%）在平均 1.9 个月后愈合，15 例溃疡（25%）在平均 12.7 个月后复发。愈合与压迫治疗呈正相关（风险比 [HR]：2.02，95%置信区间 [CI]：1.14-3.59），与溃疡持续时间呈负相关（HR：0.99，95% CI：0.98-1.0）。男性、溃疡持续时间和深静脉反流被确定为溃疡复发的显著危险因素（HR：0.14，95% CI：0.03-0.73；HR：1.02，95% CI：1.0-1.04；HR：5.4，95% CI：1.30-22.31）。
早期手术干预可提高愈合率，降低溃疡复发风险。
