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2010 Annual Meeting Abstracts
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Management of Recalcitrant Venous Leg Ulcers by Combined Split-Thickness Skin Grafting and Post-Operative Compression Therapy. .
George Perdrizet1, *Brian M Allen2, *Alan Babigian2
1Morristown Memorial Hosptial, Morristown, NJ;2Hartford Hospital, Hartford, CT
Management of Recalcitrant Venous Leg Ulcers by Combined Split-Thickness Skin Grafting and Post-Operative Compression Therapy.
Objective: To report rates of healing and recurrence following split-thickness skin grafting (STSG) of patients with recalcitrant (> 3 months of wound care) venous leg ulcers (rVLU). To describe a model of collaborative practice between surgeons and a comprehensive wound care center. Design: Retrospective, observational, IRB-approved study. Setting: An ambulatory wound care center located within a tertiary care, university-affiliated, adult hospital in a urban setting. Patients: All sequential, adult patients with the diagnosis of VLU. Venous insufficiency was confirmed by diagnostic ultrasonography. Patients with obstructive venous disease or a diagnosis of arterial insufficiency (ankle:brachial index <0.85 in the affected limb) were excluded. Intervention: Standard comprehensive wound care (debridement, compression etc) for all patients. Patients failing these measures were offered the option of closure by STSG. Outcomes: Rates of healing and recurrence (1 year). Results- A total of 138 patients and 360 wounds over a 3 year period (2005-2008). Of these, 287 (80%) wounds received standard care only and had an 89% closure rate. An additional 73 (20%) rVLU’s received a STSG and had an 84% closure rate. Seventeen patients had one-year follow up data and demonstrated a 6% recurrence rate. Post-operative care was provided by the wound care clinic to ensure continued, effective compression therapy and long-term follow-up. Conclusion- Surgeons can improve outcomes for patients with rVLU’s by using standard STSG techniques. Wound Care Centers can ensure success by incorporating aggressive post-operative compression therapy and long-term follow-up.
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