Venous leg ulcers: a prognostic index to predict time to healing.

OBJECTIVE--To evaluate the prognostic factors in uncomplicated venous leg ulcer healing. DESIGN--Randomised parallel group controlled trial with subjects stratified by initial ulcer diameter and four months'' maximum duration of follow up. SETTING--Assessment at Northwick Park Hospital vascular unit with community based treatment. PATIENTS--200 patients with clinical and objective evidence of uncomplicated venous leg ulceration and an initial ulcer diameter > 2 cm. MAIN OUTCOME MEASURE--Time to complete healing of the ulcer. RESULTS--In the presence of graduated compression healing occurred more rapidly in patients with a smaller initial ulcer area (relative risk of healing 1.92 associated with halving of ulcer area (95% confidence interval 1.58 to 2.33)), shorter duration of ulceration (relative risk 1.35 associated with halving duration (1.17 to 1.56)), younger age (relative risk 1.34 associated with 10 year decrease (1.12 to 1.59)), and no deep vein involvement (relative risk 1.8 (1.19 to 2.78)). CONCLUSION--These prognostic factors used in a simple scoring system predict time to healing.     

Tropical ulcers.

We present 87 cases of chronic leg ulcers. The ages and sexes of the patients, and the symptomatology and complications, are described. The term "tropical ulcer" is inappropriate for these cases--though the term may be appropriate for certain rare acute ulcers colonized by Vincent's bacilli. For most persistent leg ulcers in the tropics, however, a general term of chronic ulcer is better--because it stimulates one to look for the cause and to treat the patient accordingly.