Review paper
Prognostic factors for delayed healing of venous leg ulcers

Risk factors of poor healing of venous leg ulcers can be categorised into three main groups: those related to the ulcer, those related to the patient, and those related to the organisation of wound care. Identification of risk factors that predispose these patients to prolonged wound healing not only offers an opportunity to determine their clinical outcome, but can also be linked to the decision regarding alternative interventions or even reorganisation of the wound care. Factors related to the ulcer comprise large ulcer size and long ulcer duration. Also, some macroscopic features of venous leg ulcers are associated with delayed healing: fibrin covering more than 50% of the area of the wound and highly exuding ulcers. Coexisting non-venous vascular pathologies, such as arterial ischaemia or clinically relevant lymphedema, as well as history of deep vein thrombosis, can contribute to delayed healing. Additionally, pathological functioning of calf muscle pump can be associated with reduced healing. Some bacterium species seem to interfere with healing of venous leg ulcers, especially if the number of such microorganisms in the wound bed is high. Regarding patient characteristics, reduced mobility (patients being chair or bedbound) is a risk factor, while it remains unclear whether the demographic characteristics of the patients or their non-vascular co-morbidities are really associated with impaired healing. In addition, a number of studies have shown that organisation of wound care of venous leg ulcer patients appeared to be important, and healing rates improved and the cost of care declined after the implementation of an evidence-based service.