Materiały źródłowe

• #1 Why Venous Leg Ulcers Have Difficulty Healing: Overview on Pathophysiology, Clinical Consequences, and Treatment

  https://www.mdpi.com/2077-0383/10/1/29

  Venous leg ulcers (VLUs) are one of the most common ulcers of the lower extremity. VLU affects many individuals worldwide, could pose a significant socioeconomic burden to the healthcare system, and has major psychological and physical impacts on the affected individual. The prevalence of VLU is up to 2% of the population and, importantly, increases to 5% of individuals over the age of 65 years old. Venous leg ulcer is a worldwide problem in many countries and regions including the United States, the United Kingdom, Australia, India, Africa, and Europe. The number of affected individuals is staggering in Africa, with an estimated 25 to 135 million individuals having VLU and chronic wounds (with the majority of them being VLU). Europe has up to 2.2 million people affected, and over 6 million individuals are affected in the United States. However, a major issue with VLU is the high recurrence rates, which can be significant and as high as 50–70% at 6 months. The morbidity of VLU has many financial and socioeconomic impacts, especially given the high recurrence rates. The treatment of VLU is significant, involving and requiring many resources, specialties, appointments, inconveniences to the patients, wound care products, psychosocial events, and hardships and has a major healthcare burden. The associated costs for VLU care are just over $15,000 but increase significantly for patients who have delayed healing and can result in costs as high as $34,000 per patient per year, with most of the cost driven by outpatient visits, nursing care, and admissions to hospitals for related complications, usually infection.

• #2 SciELO Brazil – Systematic review of topic treatment for venous ulcers Systematic review of topic treatment for venous ulcers

  https://www.scielo.br/j/rlae/a/L4bGXSMqzzrs4JWTwVfyWsH/

  Venous ulcer patients can experience this situation for several years without achieving healing if treatment is inadequate. […] The incidence of chronic venous insufficiency is approximately 5.9% and the prevalence of venous ulcers is around 1% in the Western world, and more frequent in the elderly. […] It is observed, in health service practice, that the patient with venous ulcer is frequently attended for medical consultations, dressing changes with successive changes in topical treatment and sometimes, without association of any compression therapy. […] The use of systematic reviews can help to revert this situation because it aims to reduce a great variety of available research results, translating them in recommendations, allowing professionals to keep up to date, in addition to supporting the choice of interventions.

• #3 Treating Infected Non-Healing Venous Leg Ulcers with Medical-Grade Honey: A Prospective Case Series

  https://www.mdpi.com/2079-6382/13/7/614

  Venous leg ulcers (VLUs) are hard-to-heal wounds and are prone to microbial colonization. […] The prevalence of VLUs is up to 1.69%, and the incidence is up to 1.33% of the population, while they are the most common ulcer of the lower extremity, accounting for between 70 and 80% of all leg ulcers. […] Chronicity of VLUs constitutes a major global health issue since these hard-to-heal wounds can persist for at least 4 weeks, without a tendency to heal despite the use of appropriate treatments. […] Currently, at least 60% of VLUs result in a chronic wound, while the healing rates can be protracted, with fewer than 60% healed by 12 weeks. […] Elderly patients with severe comorbidities are more prone to microbial contamination and therefore biofilm formation resulting in protracted periods of infected and non-healing lower leg wounds.

• #4 Prevalence of venous leg ulcer: the importance of the data collection method – Servier – PhlebolymphologyServier – Phlebolymphology

  https://www.phlebolymphology.org/prevalence-of-venous-leg-ulcer-the-importance-of-the-data-collection-method/

  Many epidemiological studies have been performed to assess leg ulcer prevalence, but not all have given reliable results due to weaknesses in the methodology. […] Based on the available and most qualitative studies the overall prevalence of venous ulcers (healed + open) is, astonishingly stable between different countries and over time, around 1% in most populations. […] Venous disease is the most common causative factor for leg ulcers, but has to be properly diagnosed in order to establish a reliable diagnosis. […] The aim of this article is to point out the variations in methodology in previous epidemiological studies and how these differences can affect the result, and to present available data on venous leg ulcer prevalence. […] The incidence of venous leg ulcers is estimated to be one tenth of the current point prevalence, meaning that only one out of ten venous ulcers is newly developed.

• #5 Prevalence and incidence of venous leg ulcers—A systematic review and meta‐analysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10588327/

  Venous leg ulcers (VLU) represent a major public health challenge. Little is known about the prevalence and incidence of VLU internationally. The prevalence of VLUs is reported around 1.08% and the incidence being up to 1.33%. The latter numbers are primarily based on estimates because of the lack of clinical registries for VLU. The prevalence and incidence of VLU increase with age. VLUs continue to be of international as well as local concern. Despite proper care, up to 20% of VLUs would not heal after 2 years. They represent a considerable social and economic burden, with an estimated annual cost of 102 million sterling in the UK, $32 billion in the United States, and $3 billion in Australia. Despite this burden, there is no international systematic collation and review of existing prevalence and incidence studies. Such information on the epidemiology of VLU is necessary to inform decision-making by health services to establish best strategies for prevention and management of VLU.

• #6 Prevalence and incidence of venous leg ulcers—A systematic review and meta‐analysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10588327/

  Our results highlighted an extreme heterogeneity across effect sizes for both prevalence and incidence, which prevent a meaningful interpretation of pooled indexes and argue for further studies with specific prevalence-type reported and target population under study. Our metaanalysis of prevalence included 13 studies and resulted in a pooled VLU prevalence of 0.32%. Our systematic review included four studies reporting rates of incidences. All were incorporated in the metaanalysis with a pooled VLU incidence of 0.168%. This proportion represents about a 1/4th of the reported pooled prevalence of 0.694% in the corresponding population group (VLU patients among patients receiving care). This would indicate that one out of four VLUs is newly developed. […] Our analysis identified three different approaches to reporting prevalence that help to explain a significant amount of the heterogeneity. A statistically significant difference of VLU prevalence estimates does exist between the population subgroups. This observation reveals the variability of how prevalence can be reported and highlights the need to set up international consensus for systematic collation and review of prevalence and incidence to establish the epidemiological profile of VLU at an international level.

• #7 Venous Leg Ulcer – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK567802/

  VLUs are the most common type of chronic wound in the lower extremity. There is an estimation that 1% to 3% of the older adult population is affected in the US and Europe. An epidemiological survey from Asia, Eastern Europe, Latin America, and Western Europe showed that 2.21% of 99,359 patients with CVI had an active or healed VLU when visiting their primary care clinician for various reasons. Individual regional rates were reported at 1.27%, 2.87%, 3.97%, and 1.67%, respectively. The overall incidence is higher for women than men, although the exact number is hard to establish as it depends on the cohort and place of study. The average time from CVI diagnosis to ulceration is 5 years, according to the results from a 25-year population study. Another study’s results demonstrated that the 3-year risk for the first ulceration in people with CVI was 4.49%, ascending to 4.93% at the 5-year follow-up.

• #8 Venous Ulcers: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0901/p298.html

  Venous ulcers are the most common type of chronic lower extremity ulcers, affecting 1% to 3% of the U.S. population. Venous hypertension as a result of venous reflux (incompetence) or obstruction is thought to be the primary underlying mechanism for venous ulcer formation. Risk factors for the development of venous ulcers include age 55 years or older, family history of chronic venous insufficiency, higher body mass index, history of pulmonary embolism or superficial/deep venous thrombosis, lower extremity skeletal or joint disease, higher number of pregnancies, parental history of ankle ulcers, physical inactivity, history of ulcers, severe lipodermatosclerosis, and venous reflux in deep veins. Poor prognostic signs for healing include ulcer duration longer than three months, initial ulcer length of 10 cm or more, presence of lower limb arterial disease, advanced age, and elevated body mass index. Chronic venous ulcers significantly impact quality of life. Severe complications include infection and malignant change.

• #9 Venous leg ulcers: Clinical understanding and epidemiology

  https://www.molnlycke.com/en-CC/knowledge/insights/wound-care/venous-leg-ulcers-clinical-understanding/

  Venous leg ulceration and chronic venous insufficiency represent a significant health problem throughout the world. Compression therapy is key to successful management. […] Venous leg ulcers are a common, chronic, recurring condition, with an estimated prevalence of between 0.1% and 0.3% in the UK. […] In the UK, population prevalence rates for VLUs range from an estimated 1 in every 100 adults, or an approximate annual number of 560,000 individuals with a VLU at any given time. […] As the population ages, all these factors will escalate the cost to the patient and healthcare organisations. […] Importantly, venous leg ulceration reoccurs in up to 70% of people who are at risk. […] In the UK, as an example, venous leg ulcers have been estimated to cost the National Health Service 941m ($1.2b; 1.1b) per year.

• #10 Venous leg ulcer | Mölnlycke Advantage

  https://www.molnlycke.ae/education/wound-areas/vlu/venous-leg-ulcer/

  Venous leg ulcers are a common, chronic, recurring condition, with an estimated prevalence of between 0.1% and 0.3% in the UK. […] Up to 10% of the population in Europe and North America has venous valvular incompetence, with 0.2% developing venous ulceration. […] In the UK, population prevalence rates range for VLU are between 1.23.2 per 1,000 people, which means there are 70,000190,000 individuals in the UK with a venous leg ulcer at any time.

• #11 Venous Leg Ulcer – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK567802/

  VLUs are the most common type of chronic wound in the lower extremity. There is an estimation that 1% to 3% of the older adult population is affected in the US and Europe. An epidemiological survey from Asia, Eastern Europe, Latin America, and Western Europe showed that 2.21% of 99,359 patients with CVI had an active or healed VLU when visiting their primary care clinician for various reasons. Individual regional rates were reported at 1.27%, 2.87%, 3.97%, and 1.67%, respectively. The overall incidence is higher for women than men, although the exact number is hard to establish as it depends on the cohort and place of study. The average time from CVI diagnosis to ulceration is 5 years, according to the results from a 25-year population study. Another study’s results demonstrated that the 3-year risk for the first ulceration in people with CVI was 4.49%, ascending to 4.93% at the 5-year follow-up.

• #12 Prevalence and incidence of venous leg ulcers—A systematic review and meta‐analysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10588327/

  Our results highlighted an extreme heterogeneity across effect sizes for both prevalence and incidence, which prevent a meaningful interpretation of pooled indexes and argue for further studies with specific prevalence-type reported and target population under study. Our metaanalysis of prevalence included 13 studies and resulted in a pooled VLU prevalence of 0.32%. Our systematic review included four studies reporting rates of incidences. All were incorporated in the metaanalysis with a pooled VLU incidence of 0.168%. This proportion represents about a 1/4th of the reported pooled prevalence of 0.694% in the corresponding population group (VLU patients among patients receiving care). This would indicate that one out of four VLUs is newly developed. […] Our analysis identified three different approaches to reporting prevalence that help to explain a significant amount of the heterogeneity. A statistically significant difference of VLU prevalence estimates does exist between the population subgroups. This observation reveals the variability of how prevalence can be reported and highlights the need to set up international consensus for systematic collation and review of prevalence and incidence to establish the epidemiological profile of VLU at an international level.

• #13 Prevalence of venous leg ulcer: the importance of the data collection method – Servier – PhlebolymphologyServier – Phlebolymphology

  https://www.phlebolymphology.org/prevalence-of-venous-leg-ulcer-the-importance-of-the-data-collection-method/

  Many epidemiological studies have been performed to assess leg ulcer prevalence, but not all have given reliable results due to weaknesses in the methodology. […] Based on the available and most qualitative studies the overall prevalence of venous ulcers (healed + open) is, astonishingly stable between different countries and over time, around 1% in most populations. […] Venous disease is the most common causative factor for leg ulcers, but has to be properly diagnosed in order to establish a reliable diagnosis. […] The aim of this article is to point out the variations in methodology in previous epidemiological studies and how these differences can affect the result, and to present available data on venous leg ulcer prevalence. […] The incidence of venous leg ulcers is estimated to be one tenth of the current point prevalence, meaning that only one out of ten venous ulcers is newly developed.

• #14 Management of venous leg ulcers with a two-layer compression bandage and a polyacrylate fibre dressing :: Cambridge Media Journals

  https://journals.cambridgemedia.com.au/wpr/volume-28-number-3/management-venous-leg-ulcers-two-layer-compression-bandage-and-polyacrylate-fibre-dressing

  Venous leg ulcers (VLUs) are a common affliction in an ever ageing population. […] It is suggested that anywhere between 1.5 and 3.0 per 1,000 persons have active leg ulcers, with prevalence increasing with age to about 20 per 1000 persons older than 80 years; most leg ulcers are secondary to venous disease. […] A raise in ulceration is attributed to an ageing population and it is suggested that this disease affects up to 3% of those aged over 60 years which increases to over 5% of those aged over 80 years. […] Annual incidence estimation in the UK, Switzerland and India ranges between 0.2 to 4.5 per 1000 inhabitants. […] In the United States, it is estimated that patients with venous leg ulcers (VLUs) are using more medical resources than other patients, with an increase of their annual per-patient health expenditures up to US$7,030; employed individuals with venous ulcers are also missing 4 more days of work per year than others without venous ulcers. […] Estimates indicate that leg ulcers affect up to 3.0 per 1000 of the Australian adult population, while in New Zealand an incidence varying between 393 and 839 per 100,000 population per year has been reported.

• #15 Venous Ulcers: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0901/p298.html

  The prevalence of venous ulcers in the United States ranges from 1% to 3%. In the United States, 10% to 35% of adults have chronic venous insufficiency, and 4% of adults 65 years or older have venous ulcers. Risk factors for venous ulcers include age 55 years or older, family history of chronic venous insufficiency, higher body mass index, history of pulmonary embolism or superficial/deep venous thrombosis, lower extremity skeletal or joint disease, higher number of pregnancies, parental history of ankle ulcers, physical inactivity, history of ulcers, severe lipodermatosclerosis, and venous reflux in deep veins. Poor prognostic signs for healing include ulcer duration longer than three months, ulcer length of 10 cm (3.9 in) or more, presence of lower limb arterial disease, advanced age, and elevated body mass index.

• #16 SciELO Brasil – Abordagem de pacientes com úlcera da perna de etiologia venosa Abordagem de pacientes com úlcera da perna de etiologia venosa

  https://www.scielo.br/j/abd/a/sKS9Vk77SrYD3LwT6cyjvvz/?lang=en

  Venous ulcers are common in adult population. They cause significant socioeconomic impact due to recurrence and the long interval between onset and healing. If venous ulcers are not appropriately managed, they present high rates of healing failure and recurrence. Despite their high prevalence and importance, venous ulcers are often neglected and inadequately managed. […] Venous ulcers are very common among the adult population and their prevalence varies depending on the many study methods, population age and definitions of venous ulcer. Some articles include in their results all chronic ulcer of lower limbs and are not restricted to venous ulcers. Most studies show a prevalence of active (not healed) venous ulcers of approximately 0.3%, that is, roughly one per 350 adults, while a history of active or healed ulcer occurs in about 1% of adult population. Prevalence increases with age and it is greater than 4% in patients aged over 65 years.

• #17 Venous Ulcers: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0901/p298.html

  The prevalence of venous ulcers in the United States ranges from 1% to 3%. In the United States, 10% to 35% of adults have chronic venous insufficiency, and 4% of adults 65 years or older have venous ulcers. Risk factors for venous ulcers include age 55 years or older, family history of chronic venous insufficiency, higher body mass index, history of pulmonary embolism or superficial/deep venous thrombosis, lower extremity skeletal or joint disease, higher number of pregnancies, parental history of ankle ulcers, physical inactivity, history of ulcers, severe lipodermatosclerosis, and venous reflux in deep veins. Poor prognostic signs for healing include ulcer duration longer than three months, ulcer length of 10 cm (3.9 in) or more, presence of lower limb arterial disease, advanced age, and elevated body mass index.

• #18 Evaluation and management of chronic venous insufficiency including venous leg ulcer – UpToDate

  https://www.uptodate.com/contents/evaluation-and-management-of-chronic-venous-insufficiency-including-venous-leg-ulcer

  Chronic venous disease (CVD) includes all manifestations of venous disease, while the term chronic venous insufficiency (CVI) is used for the advanced stages of CVD, with manifestations that include pitting edema, skin changes, and chronic venous wounds (ie, ulcers). Chronic wounds are characterized as those that are „refractory and do not heal in the projected time frame, often physiologically impaired due to an underlying pathology” as compared with acute wounds that undergo a process of predicted wound healing. Venous leg ulcer (VLU) is the most common chronic wound, accounting for approximately 70 percent of lower extremity wounds. […] The prevalence of VLU is estimated to be about 4 percent of the population. VLUs are associated with prolonged disability, burdened socioeconomic impact, and significant psychosocial morbidity due to recurrence rates as high as 66 percent at five years. […] Venous hypertension, the underlying cause of CVI and VLUs, can be due to intravascular and/or extravascular etiologies.

• #19 Epidemiology – GPnotebook

  https://gpnotebook.com/en-AU/pages/cardiovascular-medicine/venous-leg-ulceration/epidemiology

  The life-time incidence of venous leg ulceration in the UK is approximately 1%. […] The point prevalence is: 1-4 per 1000 of the general population […] 25 per 1000 of those over 85 yr old. […] There is a sex bias in the incidence of venous leg ulceration: young patients (40 yr) with venous leg are predominantly male […] overall the female:male ratio is 2:1. […] In the developed world 75-90% of chronic leg ulcers are caused by venous hypertension. […] The median duration of venous ulcers is usually about 9 months. […] With specialist care rates of 70% healing at 3 months are possible. […] Although the incidence of chronic leg ulcer is spread evenly across different socioeconomic groups, in lower socioeconomic groups the ulcers take longer to heal and recurrence rates are higher.

• #20

  https://www.nhs.uk/conditions/leg-ulcer/

  Venous leg ulcers are estimated to affect around 1 in 500 people in the UK, although they become much more common with age. […] It’s estimated around 1 in 50 people over the age of 80 has one. […] Venous leg ulcers are the most common type of leg ulcer, accounting for more than 60% of all cases. […] Most venous leg ulcers heal within 6 months if they’re treated by a healthcare professional trained in compression therapy for leg ulcers. […] But unless the underlying cause of the ulcer is addressed, there’s a high risk of a venous leg ulcer coming back after treatment. […] There are several ways to help prevent developing a venous leg ulcer in people at risk.

• #21

  https://www.nhs.uk/conditions/leg-ulcer/

  Venous leg ulcers are estimated to affect around 1 in 500 people in the UK, although they become much more common with age. […] It’s estimated around 1 in 50 people over the age of 80 has one. […] Venous leg ulcers are the most common type of leg ulcer, accounting for more than 60% of all cases. […] Most venous leg ulcers heal within 6 months if they’re treated by a healthcare professional trained in compression therapy for leg ulcers. […] But unless the underlying cause of the ulcer is addressed, there’s a high risk of a venous leg ulcer coming back after treatment. […] There are several ways to help prevent developing a venous leg ulcer in people at risk.

• #22 Epidemiology – GPnotebook

  https://gpnotebook.com/en-AU/pages/cardiovascular-medicine/venous-leg-ulceration/epidemiology

  The life-time incidence of venous leg ulceration in the UK is approximately 1%. […] The point prevalence is: 1-4 per 1000 of the general population […] 25 per 1000 of those over 85 yr old. […] There is a sex bias in the incidence of venous leg ulceration: young patients (40 yr) with venous leg are predominantly male […] overall the female:male ratio is 2:1. […] In the developed world 75-90% of chronic leg ulcers are caused by venous hypertension. […] The median duration of venous ulcers is usually about 9 months. […] With specialist care rates of 70% healing at 3 months are possible. […] Although the incidence of chronic leg ulcer is spread evenly across different socioeconomic groups, in lower socioeconomic groups the ulcers take longer to heal and recurrence rates are higher.

• #23 Vascular Ulcers: Practice Essentials, Epidemiology, Etiology

  https://emedicine.medscape.com/article/1298345-overview

  In the United States, the prevalence of vascular ulcers in the general population is not known. However, as the obesity rate increases, the rate of vascular ulcers also increases because of the comorbidities that are associated with patients who are obese. In certain states, venous ulcers are seen in 2.5% of patients admitted to long-term care facilities. This rate is believed to be much higher than the overall population prevalence. […] Internationally, studies performed in Ireland and Australia estimate the prevalence of current chronic leg ulcers to be approximately 1%. Of these, most (approximately 80%) are thought to be caused by venous disease rather than arterial disease. A telephone survey performed in Sweden estimated the prevalence over time to be 9.8% for both healed and nonhealed ulcers in persons older than 70 years. […] A single-center, retrospective report by Garavello et al found that persons over age 65 years were twice as likely to have venous leg ulcers as those under 65 years and that the incidence in women was higher than in men (59.3% vs. 40.7%, respectively).

• #24 Venous Ulcers: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0901/p298.html

  Venous ulcers are the most common type of chronic lower extremity ulcers, affecting 1% to 3% of the U.S. population. Venous hypertension as a result of venous reflux (incompetence) or obstruction is thought to be the primary underlying mechanism for venous ulcer formation. Risk factors for the development of venous ulcers include age 55 years or older, family history of chronic venous insufficiency, higher body mass index, history of pulmonary embolism or superficial/deep venous thrombosis, lower extremity skeletal or joint disease, higher number of pregnancies, parental history of ankle ulcers, physical inactivity, history of ulcers, severe lipodermatosclerosis, and venous reflux in deep veins. Poor prognostic signs for healing include ulcer duration longer than three months, initial ulcer length of 10 cm or more, presence of lower limb arterial disease, advanced age, and elevated body mass index. Chronic venous ulcers significantly impact quality of life. Severe complications include infection and malignant change.

• #25 Venous Ulcers: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0901/p298.html

  The prevalence of venous ulcers in the United States ranges from 1% to 3%. In the United States, 10% to 35% of adults have chronic venous insufficiency, and 4% of adults 65 years or older have venous ulcers. Risk factors for venous ulcers include age 55 years or older, family history of chronic venous insufficiency, higher body mass index, history of pulmonary embolism or superficial/deep venous thrombosis, lower extremity skeletal or joint disease, higher number of pregnancies, parental history of ankle ulcers, physical inactivity, history of ulcers, severe lipodermatosclerosis, and venous reflux in deep veins. Poor prognostic signs for healing include ulcer duration longer than three months, ulcer length of 10 cm (3.9 in) or more, presence of lower limb arterial disease, advanced age, and elevated body mass index.

• #26 Investigation of the Effect of Deprivation on the Burden and Management of Venous Leg Ulcers: A Cohort Study Using the THIN Database | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0058948

  There has been limited examination of the contribution of socio-economic factors to the development of leg ulcers, despite the social patterning of many underlying risk factors. […] Using The Health Improvement Network (THIN) database we identified a cohort of over 14000 patients with a diagnosis of venous leg ulceration, prospectively recorded between the years 2001 and 2006, with linked area-level socio-economic information (Townsend deprivation quintile). […] The risk of incident venous leg ulceration increased for patients living in areas of higher deprivation, even after adjustment for known risk factors age and gender. […] A socio-economic gradient in venous leg ulcer disease was observed. […] The overall rates of people with venous leg ulcers who were documented as receiving guideline recommended care (2001-2006) were low.

• #27 Epidemiology – GPnotebook

  https://gpnotebook.com/en-AU/pages/cardiovascular-medicine/venous-leg-ulceration/epidemiology

  The life-time incidence of venous leg ulceration in the UK is approximately 1%. […] The point prevalence is: 1-4 per 1000 of the general population […] 25 per 1000 of those over 85 yr old. […] There is a sex bias in the incidence of venous leg ulceration: young patients (40 yr) with venous leg are predominantly male […] overall the female:male ratio is 2:1. […] In the developed world 75-90% of chronic leg ulcers are caused by venous hypertension. […] The median duration of venous ulcers is usually about 9 months. […] With specialist care rates of 70% healing at 3 months are possible. […] Although the incidence of chronic leg ulcer is spread evenly across different socioeconomic groups, in lower socioeconomic groups the ulcers take longer to heal and recurrence rates are higher.

• #28 Leg Ulcers: Symptoms and Treatment | Doctor

  https://patient.info/doctor/leg-ulcers-pro

  The UK prevalence of chronic venous ulceration is assessed as 0.15%-0.3%. Prevalence increases with age and with obesity. […] There is no difference in prevalence between socio-economic classes but, in people from lower social classes, they take longer to heal. About 80% are managed entirely in the community. […] Improvement in life expectancy is likely to increase the prevalence of leg ulcers in the population. Even at current levels, treatment of leg ulcers is a major economic burden.

• #29 Investigation of the Effect of Deprivation on the Burden and Management of Venous Leg Ulcers: A Cohort Study Using the THIN Database | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0058948

  Older venous leg ulcer patients (78-87 years) were less likely to receive Doppler-aided assessment than those aged 68-77 years (odds ratio 0.50, 95% confidence interval 0.34 to 0.75) as were patients living in areas of high deprivation (odds ratio 0.43, 95% confidence interval 0.24 to 0.78) compared to those living in areas of low deprivation. […] The first aim of this study was to determine whether socio-economic factors were associated with the incidence and prevalence of venous leg ulceration and we found a 10% increase in risk with each area-level deprivation quintile, from lowest to highest deprivation, independent of age, gender and year of study. […] The population most likely to develop leg ulcers, those living in areas of high deprivation and older people, were the least likely to receive recommended diagnostic assessment which may exacerbate existing health inequalities. […] The results of the current study provide yet more evidence of inequalities in health that have the potential to be either ameliorated or exacerbated by contact with primary care providers.

• #30 Investigation of the Effect of Deprivation on the Burden and Management of Venous Leg Ulcers: A Cohort Study Using the THIN Database | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0058948

  Older venous leg ulcer patients (78-87 years) were less likely to receive Doppler-aided assessment than those aged 68-77 years (odds ratio 0.50, 95% confidence interval 0.34 to 0.75) as were patients living in areas of high deprivation (odds ratio 0.43, 95% confidence interval 0.24 to 0.78) compared to those living in areas of low deprivation. […] The first aim of this study was to determine whether socio-economic factors were associated with the incidence and prevalence of venous leg ulceration and we found a 10% increase in risk with each area-level deprivation quintile, from lowest to highest deprivation, independent of age, gender and year of study. […] The population most likely to develop leg ulcers, those living in areas of high deprivation and older people, were the least likely to receive recommended diagnostic assessment which may exacerbate existing health inequalities. […] The results of the current study provide yet more evidence of inequalities in health that have the potential to be either ameliorated or exacerbated by contact with primary care providers.

• #31 Protocol for a longitudinal cohort study: determination of risk factors for the development of first venous leg ulcer in people with chronic venous insufficiency, the VEINS (venous insufficiency in South Florida) cohort | BMJ Open

  https://bmjopen.bmj.com/content/9/1/e023313

  Chronic venous insufficiency (CVI) affects up to one-third of the adult population yet venous leg ulcers (VLU), a significant complication of CVI, only affect 1%2% of adults in the USA. […] VLU prevalence is increasing, doubling in the last 20 years. […] The estimated prevalence of VLU has doubled in the last 20 years from 0.3% to 0.6% in adults under 65 and is up to 2.2% in adults over 65. […] Moreover, the costs associated with VLU have been increasing and represent a great burden for both the patient and public health system. Over the last 30 years, the estimated cost of treating a single, chronic VLU has more than tripled to US$34000 today. […] The aim of this study is to develop a cohort of patients with proven venous reflux that can be followed prospectively until the development of a VLU.

• #32 Venous Leg Ulcer – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK567802/

  VLUs are the most common type of chronic wound in the lower extremity. There is an estimation that 1% to 3% of the older adult population is affected in the US and Europe. An epidemiological survey from Asia, Eastern Europe, Latin America, and Western Europe showed that 2.21% of 99,359 patients with CVI had an active or healed VLU when visiting their primary care clinician for various reasons. Individual regional rates were reported at 1.27%, 2.87%, 3.97%, and 1.67%, respectively. The overall incidence is higher for women than men, although the exact number is hard to establish as it depends on the cohort and place of study. The average time from CVI diagnosis to ulceration is 5 years, according to the results from a 25-year population study. Another study’s results demonstrated that the 3-year risk for the first ulceration in people with CVI was 4.49%, ascending to 4.93% at the 5-year follow-up.

• #33 Prevalence of venous leg ulcer: the importance of the data collection method – Servier – PhlebolymphologyServier – Phlebolymphology

  https://www.phlebolymphology.org/prevalence-of-venous-leg-ulcer-the-importance-of-the-data-collection-method/

  By a repeat study in 2002 we found that the prevalence of venous ulcers had been decreased by 46% within the health care system, giving a strong indication that our changed management strategy was successful. […] The most reliable studies suggest that both point prevalence and overall prevalence of venous ulcers are still quite high and there appears to be room for management improvements in reducing the size of the problem of venous leg ulcers. […] That this is possible has been shown from Skaraborg in Sweden where leg ulcer point prevalence has been reduced by 46% within a 14-year period.

• #34 Venous Ulcers: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0901/p298.html

  Venous ulcers are the most common type of chronic lower extremity ulcers, affecting 1% to 3% of the U.S. population. Venous hypertension as a result of venous reflux (incompetence) or obstruction is thought to be the primary underlying mechanism for venous ulcer formation. Risk factors for the development of venous ulcers include age 55 years or older, family history of chronic venous insufficiency, higher body mass index, history of pulmonary embolism or superficial/deep venous thrombosis, lower extremity skeletal or joint disease, higher number of pregnancies, parental history of ankle ulcers, physical inactivity, history of ulcers, severe lipodermatosclerosis, and venous reflux in deep veins. Poor prognostic signs for healing include ulcer duration longer than three months, initial ulcer length of 10 cm or more, presence of lower limb arterial disease, advanced age, and elevated body mass index. Chronic venous ulcers significantly impact quality of life. Severe complications include infection and malignant change.

• #35 Venous Ulcers: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0901/p298.html

  The prevalence of venous ulcers in the United States ranges from 1% to 3%. In the United States, 10% to 35% of adults have chronic venous insufficiency, and 4% of adults 65 years or older have venous ulcers. Risk factors for venous ulcers include age 55 years or older, family history of chronic venous insufficiency, higher body mass index, history of pulmonary embolism or superficial/deep venous thrombosis, lower extremity skeletal or joint disease, higher number of pregnancies, parental history of ankle ulcers, physical inactivity, history of ulcers, severe lipodermatosclerosis, and venous reflux in deep veins. Poor prognostic signs for healing include ulcer duration longer than three months, ulcer length of 10 cm (3.9 in) or more, presence of lower limb arterial disease, advanced age, and elevated body mass index.

• #36 Treating Infected Non-Healing Venous Leg Ulcers with Medical-Grade Honey: A Prospective Case Series

  https://www.mdpi.com/2079-6382/13/7/614

  Venous leg ulcers (VLUs) are hard-to-heal wounds and are prone to microbial colonization. […] The prevalence of VLUs is up to 1.69%, and the incidence is up to 1.33% of the population, while they are the most common ulcer of the lower extremity, accounting for between 70 and 80% of all leg ulcers. […] Chronicity of VLUs constitutes a major global health issue since these hard-to-heal wounds can persist for at least 4 weeks, without a tendency to heal despite the use of appropriate treatments. […] Currently, at least 60% of VLUs result in a chronic wound, while the healing rates can be protracted, with fewer than 60% healed by 12 weeks. […] Elderly patients with severe comorbidities are more prone to microbial contamination and therefore biofilm formation resulting in protracted periods of infected and non-healing lower leg wounds.

• #37 Epidemiology – GPnotebook

  https://gpnotebook.com/en-AU/pages/cardiovascular-medicine/venous-leg-ulceration/epidemiology

  The life-time incidence of venous leg ulceration in the UK is approximately 1%. […] The point prevalence is: 1-4 per 1000 of the general population […] 25 per 1000 of those over 85 yr old. […] There is a sex bias in the incidence of venous leg ulceration: young patients (40 yr) with venous leg are predominantly male […] overall the female:male ratio is 2:1. […] In the developed world 75-90% of chronic leg ulcers are caused by venous hypertension. […] The median duration of venous ulcers is usually about 9 months. […] With specialist care rates of 70% healing at 3 months are possible. […] Although the incidence of chronic leg ulcer is spread evenly across different socioeconomic groups, in lower socioeconomic groups the ulcers take longer to heal and recurrence rates are higher.

• #38 Venous Ulcers: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0901/p298.html

  Complications of venous ulcers include infections and skin cancers such as squamous cell carcinoma. Venous ulcers are a major cause of morbidity and can lead to high medical costs. Economic and personal impacts include frequent visits to health care facilities, loss of productivity, increased disability, discomfort, need for dressing changes, and recurrent hospitalizations. In one study, patients with venous ulcers used more medical resources than those without, and their annual per-patient health expenditures were increased by $6,391 for those with Medicare and $7,030 for those with private health insurance. Employed individuals with venous ulcers missed four more days of work per year than those without venous ulcers (29% increase in work-loss costs). […] The recurrence rate of venous ulcers has been reported as high as 70%. Venous intervention and long-term use of compression stockings are important for preventing recurrence, and leg elevation can be beneficial when used with compression stockings. Exercise should be encouraged to improve calf muscle pump function. Good social support and self-efficacy have also been shown to help prevent venous ulcer recurrence.

• #39 Venous ulcer – Wikipedia

  https://en.wikipedia.org/wiki/Venous_ulcer

  Venous ulcers are wounds that are thought to occur due to improper functioning of venous valves, usually of the legs (hence leg ulcers). They are an important cause of chronic wounds, affecting 1% of the population. […] The NICE guideline recommends that everyone with a venous leg ulcer, even if healed, should be referred to a vascular specialist for venous duplex ultrasound and assessment for endovenous surgery. […] Venous ulcers are costly to treat, and there is a significant chance that they will recur after healing; one study found that up to 48% of venous ulcers had recurred by the fifth year after healing. However treatment with local anaesthetic endovenous techniques suggests a reduction of this high recurrence rate is possible. […] The current 'best’ practice in the UK is to treat the underlying venous reflux once an ulcer has healed. It is questionable as to whether endovenous treatment should be offered before ulcer healing, as current evidence would not support this approach as standard care.

• #40 Practice Nursing – Recurrent venous leg ulcers: management in general practice

  https://www.practicenursing.com/content/clinical-focus/recurrent-venous-leg-ulcers-management-in-general-practice/

  Venous leg ulcers commonly recur. […] Chronic venous leg ulcers are commonly seen in general practice and although healing rates for leg ulcers have improved, recurrence rates are high with around 6070% reported to recur after healing. […] Despite improved healing rates, however, recurrence rates are depressingly high. Around 6070% of all VLUs are reported to recur after healing, with the highest recurrence rate within 3 months and the majority recurring within 12 months. […] A quarter of all patients will experience in excess of 10 episodes of active ulceration in their lifetime.

• #41 SciELO Brasil – Abordagem de pacientes com úlcera da perna de etiologia venosa Abordagem de pacientes com úlcera da perna de etiologia venosa

  https://www.scielo.br/j/abd/a/sKS9Vk77SrYD3LwT6cyjvvz/?lang=en

  Venous ulcers cause significant social and economic impact due to their recurrent nature and long lasting course between onset and healing. When they are not properly managed, about 30% of the healed venous ulcers relapse within the first year, and that increases to 78% after two years. […] In spite of high prevalence and importance of venous ulcer, it is frequently neglected and inadequately treated.

• #42 Venous Ulcers: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0901/p298.html

  Venous ulcers are the most common type of chronic lower extremity ulcers, affecting 1% to 3% of the U.S. population. Venous hypertension as a result of venous reflux (incompetence) or obstruction is thought to be the primary underlying mechanism for venous ulcer formation. Risk factors for the development of venous ulcers include age 55 years or older, family history of chronic venous insufficiency, higher body mass index, history of pulmonary embolism or superficial/deep venous thrombosis, lower extremity skeletal or joint disease, higher number of pregnancies, parental history of ankle ulcers, physical inactivity, history of ulcers, severe lipodermatosclerosis, and venous reflux in deep veins. Poor prognostic signs for healing include ulcer duration longer than three months, initial ulcer length of 10 cm or more, presence of lower limb arterial disease, advanced age, and elevated body mass index. Chronic venous ulcers significantly impact quality of life. Severe complications include infection and malignant change.

• #43 The impact of venous leg ulcers on a patient’s quality of life: considerations for dressing selection – Wounds International

  https://woundsinternational.com/journal-articles/the-impact-of-venous-leg-ulcers-on-a-patients-quality-of-life-considerations-for-dressing-selection/

  From a patient perspective, the results of numerous studies confirm a strong link between VLUs and reduced QoL. […] A systematic review of relevant national and international articles published from 2012 to 2016 confirmed that VLUs act on patients bio-psycho-social-spiritual and socioeconomic spheres, having a negative impact on their quality of life (Joaquim et al, 2018). […] As well as being challenging clinically and economically, VLUs cause patients a wide range of psychosocial issues including depression, anxiety and social isolation. While the underlying causes of VLUs can be effectively addressed with the use of compression therapy, it is equally or more important for clinicians to provide appropriate local ulcer management to minimise the impact that high exudation (e.g. leakage and maceration), malodour, pain and frequent dressing changes can have on the health-related QoL of patients (e.g. embarrassment, distress and self-isolation).

• #44 The impact of venous leg ulcers on a patient’s quality of life: considerations for dressing selection – Wounds International

  https://woundsinternational.com/journal-articles/the-impact-of-venous-leg-ulcers-on-a-patients-quality-of-life-considerations-for-dressing-selection/

  From a patient perspective, the results of numerous studies confirm a strong link between VLUs and reduced QoL. […] A systematic review of relevant national and international articles published from 2012 to 2016 confirmed that VLUs act on patients bio-psycho-social-spiritual and socioeconomic spheres, having a negative impact on their quality of life (Joaquim et al, 2018). […] As well as being challenging clinically and economically, VLUs cause patients a wide range of psychosocial issues including depression, anxiety and social isolation. While the underlying causes of VLUs can be effectively addressed with the use of compression therapy, it is equally or more important for clinicians to provide appropriate local ulcer management to minimise the impact that high exudation (e.g. leakage and maceration), malodour, pain and frequent dressing changes can have on the health-related QoL of patients (e.g. embarrassment, distress and self-isolation).

• #45 The impact of venous leg ulcers on a patient’s quality of life: considerations for dressing selection – Wounds International

  https://woundsinternational.com/journal-articles/the-impact-of-venous-leg-ulcers-on-a-patients-quality-of-life-considerations-for-dressing-selection/

  From a patient perspective, the results of numerous studies confirm a strong link between VLUs and reduced QoL. […] A systematic review of relevant national and international articles published from 2012 to 2016 confirmed that VLUs act on patients bio-psycho-social-spiritual and socioeconomic spheres, having a negative impact on their quality of life (Joaquim et al, 2018). […] As well as being challenging clinically and economically, VLUs cause patients a wide range of psychosocial issues including depression, anxiety and social isolation. While the underlying causes of VLUs can be effectively addressed with the use of compression therapy, it is equally or more important for clinicians to provide appropriate local ulcer management to minimise the impact that high exudation (e.g. leakage and maceration), malodour, pain and frequent dressing changes can have on the health-related QoL of patients (e.g. embarrassment, distress and self-isolation).

• #46 Prevalence and incidence of venous leg ulcers—A systematic review and meta‐analysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10588327/

  Venous leg ulcers (VLU) represent a major public health challenge. Little is known about the prevalence and incidence of VLU internationally. The prevalence of VLUs is reported around 1.08% and the incidence being up to 1.33%. The latter numbers are primarily based on estimates because of the lack of clinical registries for VLU. The prevalence and incidence of VLU increase with age. VLUs continue to be of international as well as local concern. Despite proper care, up to 20% of VLUs would not heal after 2 years. They represent a considerable social and economic burden, with an estimated annual cost of 102 million sterling in the UK, $32 billion in the United States, and $3 billion in Australia. Despite this burden, there is no international systematic collation and review of existing prevalence and incidence studies. Such information on the epidemiology of VLU is necessary to inform decision-making by health services to establish best strategies for prevention and management of VLU.

• #47 Why Venous Leg Ulcers Have Difficulty Healing: Overview on Pathophysiology, Clinical Consequences, and Treatment

  https://www.mdpi.com/2077-0383/10/1/29

  Venous leg ulcers (VLUs) are one of the most common ulcers of the lower extremity. VLU affects many individuals worldwide, could pose a significant socioeconomic burden to the healthcare system, and has major psychological and physical impacts on the affected individual. The prevalence of VLU is up to 2% of the population and, importantly, increases to 5% of individuals over the age of 65 years old. Venous leg ulcer is a worldwide problem in many countries and regions including the United States, the United Kingdom, Australia, India, Africa, and Europe. The number of affected individuals is staggering in Africa, with an estimated 25 to 135 million individuals having VLU and chronic wounds (with the majority of them being VLU). Europe has up to 2.2 million people affected, and over 6 million individuals are affected in the United States. However, a major issue with VLU is the high recurrence rates, which can be significant and as high as 50–70% at 6 months. The morbidity of VLU has many financial and socioeconomic impacts, especially given the high recurrence rates. The treatment of VLU is significant, involving and requiring many resources, specialties, appointments, inconveniences to the patients, wound care products, psychosocial events, and hardships and has a major healthcare burden. The associated costs for VLU care are just over $15,000 but increase significantly for patients who have delayed healing and can result in costs as high as $34,000 per patient per year, with most of the cost driven by outpatient visits, nursing care, and admissions to hospitals for related complications, usually infection.

• #48 Venous leg ulcers: Clinical understanding and epidemiology

  https://www.molnlycke.com/en-CC/knowledge/insights/wound-care/venous-leg-ulcers-clinical-understanding/

  Venous leg ulceration and chronic venous insufficiency represent a significant health problem throughout the world. Compression therapy is key to successful management. […] Venous leg ulcers are a common, chronic, recurring condition, with an estimated prevalence of between 0.1% and 0.3% in the UK. […] In the UK, population prevalence rates for VLUs range from an estimated 1 in every 100 adults, or an approximate annual number of 560,000 individuals with a VLU at any given time. […] As the population ages, all these factors will escalate the cost to the patient and healthcare organisations. […] Importantly, venous leg ulceration reoccurs in up to 70% of people who are at risk. […] In the UK, as an example, venous leg ulcers have been estimated to cost the National Health Service 941m ($1.2b; 1.1b) per year.

• #49 The impact of venous leg ulcers on a patient’s quality of life: considerations for dressing selection – Wounds International

  https://woundsinternational.com/journal-articles/the-impact-of-venous-leg-ulcers-on-a-patients-quality-of-life-considerations-for-dressing-selection/

  A vast majority (70%) of lower-extremity ulcers are caused by chronic venous insufficiency (CVI). In the US and Europe, people 65 years of age are vulnerable to VLUs. The prevalence of VLUs is 1% of the population globally among those aged 1864. In the US, 1035% of the population suffer from chronic venous issues with 4% (65 age group) of the cases having active ulcers (Sen, 2019). […] The direct costs associated with the management of patients with VLUs from the perspective of the UKs National Health Service (NHS) have been estimated to be 7,706 per patient per year, which translates to an annual cost exceeding 2 billion when extrapolated to the UK population (Phillips et al, 2020). In the US, it has been estimated that the annual Medicare and commercial insurance costs associated with VLU treatment are close to $1 billion, with an annual US taxpayer burden of around $14.9 billion (Bradford Rice et al, 2014).

• #50 Prevalence and incidence of venous leg ulcers—A systematic review and meta‐analysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10588327/

  Venous leg ulcers (VLU) represent a major public health challenge. Little is known about the prevalence and incidence of VLU internationally. The prevalence of VLUs is reported around 1.08% and the incidence being up to 1.33%. The latter numbers are primarily based on estimates because of the lack of clinical registries for VLU. The prevalence and incidence of VLU increase with age. VLUs continue to be of international as well as local concern. Despite proper care, up to 20% of VLUs would not heal after 2 years. They represent a considerable social and economic burden, with an estimated annual cost of 102 million sterling in the UK, $32 billion in the United States, and $3 billion in Australia. Despite this burden, there is no international systematic collation and review of existing prevalence and incidence studies. Such information on the epidemiology of VLU is necessary to inform decision-making by health services to establish best strategies for prevention and management of VLU.

• #51 Why Venous Leg Ulcers Have Difficulty Healing: Overview on Pathophysiology, Clinical Consequences, and Treatment

  https://www.mdpi.com/2077-0383/10/1/29

  Venous leg ulcers (VLUs) are one of the most common ulcers of the lower extremity. VLU affects many individuals worldwide, could pose a significant socioeconomic burden to the healthcare system, and has major psychological and physical impacts on the affected individual. The prevalence of VLU is up to 2% of the population and, importantly, increases to 5% of individuals over the age of 65 years old. Venous leg ulcer is a worldwide problem in many countries and regions including the United States, the United Kingdom, Australia, India, Africa, and Europe. The number of affected individuals is staggering in Africa, with an estimated 25 to 135 million individuals having VLU and chronic wounds (with the majority of them being VLU). Europe has up to 2.2 million people affected, and over 6 million individuals are affected in the United States. However, a major issue with VLU is the high recurrence rates, which can be significant and as high as 50–70% at 6 months. The morbidity of VLU has many financial and socioeconomic impacts, especially given the high recurrence rates. The treatment of VLU is significant, involving and requiring many resources, specialties, appointments, inconveniences to the patients, wound care products, psychosocial events, and hardships and has a major healthcare burden. The associated costs for VLU care are just over $15,000 but increase significantly for patients who have delayed healing and can result in costs as high as $34,000 per patient per year, with most of the cost driven by outpatient visits, nursing care, and admissions to hospitals for related complications, usually infection.

• #52 Venous Ulcers: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0901/p298.html

  Complications of venous ulcers include infections and skin cancers such as squamous cell carcinoma. Venous ulcers are a major cause of morbidity and can lead to high medical costs. Economic and personal impacts include frequent visits to health care facilities, loss of productivity, increased disability, discomfort, need for dressing changes, and recurrent hospitalizations. In one study, patients with venous ulcers used more medical resources than those without, and their annual per-patient health expenditures were increased by $6,391 for those with Medicare and $7,030 for those with private health insurance. Employed individuals with venous ulcers missed four more days of work per year than those without venous ulcers (29% increase in work-loss costs). […] The recurrence rate of venous ulcers has been reported as high as 70%. Venous intervention and long-term use of compression stockings are important for preventing recurrence, and leg elevation can be beneficial when used with compression stockings. Exercise should be encouraged to improve calf muscle pump function. Good social support and self-efficacy have also been shown to help prevent venous ulcer recurrence.

• #53 Why Venous Leg Ulcers Have Difficulty Healing: Overview on Pathophysiology, Clinical Consequences, and Treatment

  https://www.mdpi.com/2077-0383/10/1/29

  Venous leg ulcers (VLUs) are one of the most common ulcers of the lower extremity. VLU affects many individuals worldwide, could pose a significant socioeconomic burden to the healthcare system, and has major psychological and physical impacts on the affected individual. The prevalence of VLU is up to 2% of the population and, importantly, increases to 5% of individuals over the age of 65 years old. Venous leg ulcer is a worldwide problem in many countries and regions including the United States, the United Kingdom, Australia, India, Africa, and Europe. The number of affected individuals is staggering in Africa, with an estimated 25 to 135 million individuals having VLU and chronic wounds (with the majority of them being VLU). Europe has up to 2.2 million people affected, and over 6 million individuals are affected in the United States. However, a major issue with VLU is the high recurrence rates, which can be significant and as high as 50–70% at 6 months. The morbidity of VLU has many financial and socioeconomic impacts, especially given the high recurrence rates. The treatment of VLU is significant, involving and requiring many resources, specialties, appointments, inconveniences to the patients, wound care products, psychosocial events, and hardships and has a major healthcare burden. The associated costs for VLU care are just over $15,000 but increase significantly for patients who have delayed healing and can result in costs as high as $34,000 per patient per year, with most of the cost driven by outpatient visits, nursing care, and admissions to hospitals for related complications, usually infection.

• #54 Venous leg ulcers: Clinical understanding and epidemiology

  https://www.molnlycke.com/en-CC/knowledge/insights/wound-care/venous-leg-ulcers-clinical-understanding/

  Most of this healthcare cost is due to community nursing services, as district nurses in the UK spend up to 80% their time caring for patients with leg ulcers. […] Venous leg ulceration is often a chronic condition, and patients experience a prolonged cycle of skin healing and then breakdown. […] This cycle of wound healing and reversal sometimes repeats over decades, with episodes of infection, all of which can impair quality of life.

• #55 Venous Ulcers: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0901/p298.html

  Complications of venous ulcers include infections and skin cancers such as squamous cell carcinoma. Venous ulcers are a major cause of morbidity and can lead to high medical costs. Economic and personal impacts include frequent visits to health care facilities, loss of productivity, increased disability, discomfort, need for dressing changes, and recurrent hospitalizations. In one study, patients with venous ulcers used more medical resources than those without, and their annual per-patient health expenditures were increased by $6,391 for those with Medicare and $7,030 for those with private health insurance. Employed individuals with venous ulcers missed four more days of work per year than those without venous ulcers (29% increase in work-loss costs). […] The recurrence rate of venous ulcers has been reported as high as 70%. Venous intervention and long-term use of compression stockings are important for preventing recurrence, and leg elevation can be beneficial when used with compression stockings. Exercise should be encouraged to improve calf muscle pump function. Good social support and self-efficacy have also been shown to help prevent venous ulcer recurrence.

• #56 Venous Ulcers By The Numbers

  https://www.thewca.com/blog/venous-ulcers-by-the-numbers

  Venous leg ulcers (VLUs) are the most common type of ulcers found on the leg. They account for up to 90% of lower leg ulcers: […] Approximately 600,000 individuals develop a VLU annually: […] 30% of venous leg ulcers remain unhealed after a 24 week period: […] In the US, venous leg ulcers cost the health system around 2.5 billion: […] An average of 2 million working days are lost every year because of venous leg ulcers.

• #57 Venous Ulcers: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0901/p298.html

  Complications of venous ulcers include infections and skin cancers such as squamous cell carcinoma. Venous ulcers are a major cause of morbidity and can lead to high medical costs. Economic and personal impacts include frequent visits to health care facilities, loss of productivity, increased disability, discomfort, need for dressing changes, and recurrent hospitalizations. In one study, patients with venous ulcers used more medical resources than those without, and their annual per-patient health expenditures were increased by $6,391 for those with Medicare and $7,030 for those with private health insurance. Employed individuals with venous ulcers missed four more days of work per year than those without venous ulcers (29% increase in work-loss costs). […] The recurrence rate of venous ulcers has been reported as high as 70%. Venous intervention and long-term use of compression stockings are important for preventing recurrence, and leg elevation can be beneficial when used with compression stockings. Exercise should be encouraged to improve calf muscle pump function. Good social support and self-efficacy have also been shown to help prevent venous ulcer recurrence.

• #58 Prevalence and incidence of venous leg ulcers—A systematic review and meta‐analysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10588327/

  Our results highlighted an extreme heterogeneity across effect sizes for both prevalence and incidence, which prevent a meaningful interpretation of pooled indexes and argue for further studies with specific prevalence-type reported and target population under study. Our metaanalysis of prevalence included 13 studies and resulted in a pooled VLU prevalence of 0.32%. Our systematic review included four studies reporting rates of incidences. All were incorporated in the metaanalysis with a pooled VLU incidence of 0.168%. This proportion represents about a 1/4th of the reported pooled prevalence of 0.694% in the corresponding population group (VLU patients among patients receiving care). This would indicate that one out of four VLUs is newly developed. […] Our analysis identified three different approaches to reporting prevalence that help to explain a significant amount of the heterogeneity. A statistically significant difference of VLU prevalence estimates does exist between the population subgroups. This observation reveals the variability of how prevalence can be reported and highlights the need to set up international consensus for systematic collation and review of prevalence and incidence to establish the epidemiological profile of VLU at an international level.

• #59 Prevalence of venous leg ulcer: the importance of the data collection method – Servier – PhlebolymphologyServier – Phlebolymphology

  https://www.phlebolymphology.org/prevalence-of-venous-leg-ulcer-the-importance-of-the-data-collection-method/

  Many epidemiological studies have been performed to assess leg ulcer prevalence, but not all have given reliable results due to weaknesses in the methodology. […] Based on the available and most qualitative studies the overall prevalence of venous ulcers (healed + open) is, astonishingly stable between different countries and over time, around 1% in most populations. […] Venous disease is the most common causative factor for leg ulcers, but has to be properly diagnosed in order to establish a reliable diagnosis. […] The aim of this article is to point out the variations in methodology in previous epidemiological studies and how these differences can affect the result, and to present available data on venous leg ulcer prevalence. […] The incidence of venous leg ulcers is estimated to be one tenth of the current point prevalence, meaning that only one out of ten venous ulcers is newly developed.

• #60 Prevalence of venous leg ulcer: the importance of the data collection method – Servier – PhlebolymphologyServier – Phlebolymphology

  https://www.phlebolymphology.org/prevalence-of-venous-leg-ulcer-the-importance-of-the-data-collection-method/

  Many epidemiological studies have been performed to assess leg ulcer prevalence, but not all have given reliable results due to weaknesses in the methodology. […] Based on the available and most qualitative studies the overall prevalence of venous ulcers (healed + open) is, astonishingly stable between different countries and over time, around 1% in most populations. […] Venous disease is the most common causative factor for leg ulcers, but has to be properly diagnosed in order to establish a reliable diagnosis. […] The aim of this article is to point out the variations in methodology in previous epidemiological studies and how these differences can affect the result, and to present available data on venous leg ulcer prevalence. […] The incidence of venous leg ulcers is estimated to be one tenth of the current point prevalence, meaning that only one out of ten venous ulcers is newly developed.

• #61 Prevalence and incidence of venous leg ulcers—A systematic review and meta‐analysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10588327/

  Venous leg ulcers (VLU) represent a major public health challenge. Little is known about the prevalence and incidence of VLU internationally. The prevalence of VLUs is reported around 1.08% and the incidence being up to 1.33%. The latter numbers are primarily based on estimates because of the lack of clinical registries for VLU. The prevalence and incidence of VLU increase with age. VLUs continue to be of international as well as local concern. Despite proper care, up to 20% of VLUs would not heal after 2 years. They represent a considerable social and economic burden, with an estimated annual cost of 102 million sterling in the UK, $32 billion in the United States, and $3 billion in Australia. Despite this burden, there is no international systematic collation and review of existing prevalence and incidence studies. Such information on the epidemiology of VLU is necessary to inform decision-making by health services to establish best strategies for prevention and management of VLU.

• #62 Prevalence and incidence of venous leg ulcers—a protocol for a systematic review | Systematic Reviews | Full Text

  https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-021-01697-3

  Venous leg ulcers (VLUs) are chronic wounds characterized by slow healing and high recurrence. Information on prevalence and incidence is essential for ascertaining the burden of VLU on the health care system and to inform epidemiological research, priority setting, and health care planning. […] VLUs are most prevalent among persons of older age with concomitant chronic venous insufficiency. They impact more females than males, those who are obese, immobile, have a congenital absence of veins, or a history of deep vein thrombosis (DVT) or phlebitis resulting in reduced mobility, poor quality of life, and notable financial burden on patients and health care systems. […] Three VLU studies have reported prevalence and incidence of populations in various settings ranging for prevalence from 0.12% to 1.69% and for incidences from 0.3% to 1.33%. This observed variability of occurrence may be in part due to a lack of a clinical registry for VLU and the different methodologies used to collect prevalence and incidence data.

• #63 Prevalence and incidence of venous leg ulcers—A systematic review and meta‐analysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10588327/

  Our results highlighted an extreme heterogeneity across effect sizes for both prevalence and incidence, which prevent a meaningful interpretation of pooled indexes and argue for further studies with specific prevalence-type reported and target population under study. Our metaanalysis of prevalence included 13 studies and resulted in a pooled VLU prevalence of 0.32%. Our systematic review included four studies reporting rates of incidences. All were incorporated in the metaanalysis with a pooled VLU incidence of 0.168%. This proportion represents about a 1/4th of the reported pooled prevalence of 0.694% in the corresponding population group (VLU patients among patients receiving care). This would indicate that one out of four VLUs is newly developed. […] Our analysis identified three different approaches to reporting prevalence that help to explain a significant amount of the heterogeneity. A statistically significant difference of VLU prevalence estimates does exist between the population subgroups. This observation reveals the variability of how prevalence can be reported and highlights the need to set up international consensus for systematic collation and review of prevalence and incidence to establish the epidemiological profile of VLU at an international level.

• #64 Prevalence and incidence of venous leg ulcers—a protocol for a systematic review | Systematic Reviews | Full Text

  https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-021-01697-3

  As the number of people with VLUs across the globe is expected to rise in the future due to an aging and an increasingly overweight population, a systematic collation and review of existing prevalence and incidence studies on VLU will inform decision making, priority setting and health care planning as well as future research. […] This protocol for a systematic review will employ strict methodological inclusion and exclusion criteria of published and available literature to identify prevalence and incidence of VLU internationally and will characterize the population as reported in these studies. […] The objective of this systematic review protocol is to present a transparent process. […] The primary outcomes will be period prevalence or point prevalence or cumulative incidence or incidence rate of VLU.

• #65 Prevalence and incidence of venous leg ulcers—a protocol for a systematic review | Systematic Reviews | Full Text

  https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-021-01697-3

  The results of this systematic review will provide key stakeholders with an overview of VLU prevalence, incidence, and VLU determinants. This information will inform healthcare professionals, policy-makers, and consumers in making evidence-based decisions that effectively target and address the VLU burden and will inform future research in this area.

• #66 Epidemiology of chronic venous disease in Mexico and its impact on quality of life

  http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S2696-130X2023000200035

  Epidemiological data on chronic venous disease (CVD) are important for developing prevention and treatment programs. […] We reviewed the epidemiological data gathered from Mexican population on CVD and its impact on quality of life (QoL). […] The prevalence of CVD was 71.3%, predominantly in women (76.3%), and the mean age was 44.7 years. […] This review provides reliable data showing that CVD is highly prevalent in Mexico and affects QoL as it progresses. […] In Mexico, epidemiological information on CVD is limited, and what is available has been gathered either in regional settings or in specific occupational groups. […] This study represents one of the largest recent epidemiological studies focusing on vein disease in the Mexican population. […] It provides reliable data on the high prevalence of CVD and how the QoL of patients deteriorates as the disease progresses to more severe stages.

• #67 Prevalence and incidence of venous leg ulcers—a protocol for a systematic review | Systematic Reviews | Full Text

  https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-021-01697-3

  As the number of people with VLUs across the globe is expected to rise in the future due to an aging and an increasingly overweight population, a systematic collation and review of existing prevalence and incidence studies on VLU will inform decision making, priority setting and health care planning as well as future research. […] This protocol for a systematic review will employ strict methodological inclusion and exclusion criteria of published and available literature to identify prevalence and incidence of VLU internationally and will characterize the population as reported in these studies. […] The objective of this systematic review protocol is to present a transparent process. […] The primary outcomes will be period prevalence or point prevalence or cumulative incidence or incidence rate of VLU.

• #68 Computerised prediction of healing for venous leg ulcers | Scientific Reports

  https://www.nature.com/articles/s41598-022-20835-y

  Early prediction of delayed healing for venous leg ulcers could improve management outcomes by enabling earlier initiation of adjuvant therapies. […] Unfortunately, the prevalence of venous leg ulceration in the general population is not accurately known, but estimated at approximately 1%, with prevalence increasing with increasing age. […] Venous leg ulcers (VLU) cause a significant negative impact on the quality of life of individuals and the economic burden on individuals and the health system required to assess and manage the issue is also considerable. […] Despite best practice management, over 20% of ulcers do not heal in the expected trajectory and may require additional interventions to improve outcomes. […] Currently, the prediction of healing for chronic VLU (and other chronic wounds) is undertaken by measuring the wound area using digital planimetry and reviewing the area after at least 2 and often up to 4 weeks.

• #69 Computerised prediction of healing for venous leg ulcers | Scientific Reports

  https://www.nature.com/articles/s41598-022-20835-y

  A method that is non-contact, and which can provide this information at the first appointment can support the early implementation of appropriate management to enable improved healing trajectories. […] This study identified that using textural features of thermal images taken at the first assessment (week 0) of the VLU can predict whether the wound would heal by week 12. […] The results show that the software was able to predict the healing label in week 0 with an average of 71.43% sensitivity and 60% specificity. […] The potential usefulness of the proposed algorithm for the prediction of healing status is confirmed with evidence from the classification results averaged over 20 repetitions. […] Future research should focus on improving the predictive accuracy and customising this method to incorporate this assessment into clinical practice on a wider pool of participants and in a variety of settings.

• #70 Computerised prediction of healing for venous leg ulcers | Scientific Reports

  https://www.nature.com/articles/s41598-022-20835-y

  A method that is non-contact, and which can provide this information at the first appointment can support the early implementation of appropriate management to enable improved healing trajectories. […] This study identified that using textural features of thermal images taken at the first assessment (week 0) of the VLU can predict whether the wound would heal by week 12. […] The results show that the software was able to predict the healing label in week 0 with an average of 71.43% sensitivity and 60% specificity. […] The potential usefulness of the proposed algorithm for the prediction of healing status is confirmed with evidence from the classification results averaged over 20 repetitions. […] Future research should focus on improving the predictive accuracy and customising this method to incorporate this assessment into clinical practice on a wider pool of participants and in a variety of settings.

• #71 Protocol for a longitudinal cohort study: determination of risk factors for the development of first venous leg ulcer in people with chronic venous insufficiency, the VEINS (venous insufficiency in South Florida) cohort | BMJ Open

  https://bmjopen.bmj.com/content/9/1/e023313

  Chronic venous insufficiency (CVI) affects up to one-third of the adult population yet venous leg ulcers (VLU), a significant complication of CVI, only affect 1%2% of adults in the USA. […] VLU prevalence is increasing, doubling in the last 20 years. […] The estimated prevalence of VLU has doubled in the last 20 years from 0.3% to 0.6% in adults under 65 and is up to 2.2% in adults over 65. […] Moreover, the costs associated with VLU have been increasing and represent a great burden for both the patient and public health system. Over the last 30 years, the estimated cost of treating a single, chronic VLU has more than tripled to US$34000 today. […] The aim of this study is to develop a cohort of patients with proven venous reflux that can be followed prospectively until the development of a VLU.

• #72 Protocol for a longitudinal cohort study: determination of risk factors for the development of first venous leg ulcer in people with chronic venous insufficiency, the VEINS (venous insufficiency in South Florida) cohort | BMJ Open

  https://bmjopen.bmj.com/content/9/1/e023313

  Previous studies have looked at recurrence rates and associated risk factors regarding venous ulcers, but data regarding fVLU are quite limited. […] The VEINS cohort study seeks to determine, in a prospective fashion, the roles of traditional CVI risk factors and novel risk or protective factors in the development of fVLU.

• #73 Protocol for a longitudinal cohort study: determination of risk factors for the development of first venous leg ulcer in people with chronic venous insufficiency, the VEINS (venous insufficiency in South Florida) cohort | BMJ Open

  https://bmjopen.bmj.com/content/9/1/e023313

  Previous studies have looked at recurrence rates and associated risk factors regarding venous ulcers, but data regarding fVLU are quite limited. […] The VEINS cohort study seeks to determine, in a prospective fashion, the roles of traditional CVI risk factors and novel risk or protective factors in the development of fVLU.

• #74 Aspirin in venous leg ulcer study (ASPiVLU): study protocol for a randomised controlled trial | Trials | Full Text

  https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-016-1314-4

  Venous leg ulcers (VLUs) are a common and costly problem, usually managed in general practice and community settings with variability in clinical practice. Age-related venous leg ulceration is the most common cause of lower limb ulceration in developed countries, with an overall prevalence between 1.65 and 1.74 % and substantially higher rates in adults of age 65 and older. In 2010, an estimated 400,000 Australians were treated for VLUs, translating into costs of more than AU$3 billion per year. The natural history of ulceration is a cycle of healing and recurrence, which has considerable impact on an individual’s health, quality of life, and socioeconomic costs. Increasing life expectancy means that more people will be living with VLUs in the future, increasing the financial and healthcare burden of this already costly chronic disease.

• #75 Aspirin in venous leg ulcer study (ASPiVLU): study protocol for a randomised controlled trial | Trials | Full Text

  https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-016-1314-4

  Best practice VLU treatment is a firm graduated compression bandage to aid venous return. Data shows that VLUs heal more quickly with compression than without. Many healed ulcers recur within 3 months of healing, possibly due to a prolonged inflammatory response. Aspirin is a widely used and relatively well-tolerated drug. It has the potential to reduce inflammation via generalised COX inhibition. […] The ASPiVLU trial will investigate the efficacy and safety of aspirin as an adjunct to compression therapy to treat venous leg ulcers. The primary objective is to determine whether daily aspirin (300 mg) as an adjunct to compression improves the time to healing of the target ulcer in a 12-week treatment period. The secondary objective is to determine the effects of aspirin on ulcer recurrence, wound pain, quality of life and wellbeing, adherence to study medication, adherence to compression therapy, serum inflammatory markers, hospitalisations, and adverse events at 24 weeks.

• #76 Aspirin in venous leg ulcer study (ASPiVLU): study protocol for a randomised controlled trial | Trials | Full Text

  https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-016-1314-4

  Two small, randomised, controlled trials (RCTs) suggest aspirin may be effective in speeding ulcer healing and may reduce the ulcer recurrence, although the quality of this evidence is low. The ASPiVLU study in Australia will investigate the effects of aspirin in people with VLUs in a large, randomised, double-blinded, placebo-controlled trial. […] This protocol outlines the design of a randomised, double-blinded, multicentre, placebo-controlled, clinical trial of aspirin in the management of VLUs. ASPiVLU will allow us to answer the question of whether daily active treatment with 300 mg aspirin improves time to healing of venous leg ulcers. Low-dose aspirin therapy may improve time to healing and decrease the number of recurrent VLU episodes. If proved effective, the low cost of aspirin therapy as an adjunct to compression would make it an affordable preventive agent for people with VLUs in all countries. […] […] Two other randomised trials investigating aspirin in people with venous leg ulcers are ongoing: the AVURT (Aspirin for Venous Ulcers: Randomised Trial NCT02333123) and the Aspirin4VLU (Low-Dose Aspirin for Venous Leg Ulcers NTC 02158806).

• #77 Aspirin in venous leg ulcer study (ASPiVLU): study protocol for a randomised controlled trial | Trials | Full Text

  https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-016-1314-4

  Two small, randomised, controlled trials (RCTs) suggest aspirin may be effective in speeding ulcer healing and may reduce the ulcer recurrence, although the quality of this evidence is low. The ASPiVLU study in Australia will investigate the effects of aspirin in people with VLUs in a large, randomised, double-blinded, placebo-controlled trial. […] This protocol outlines the design of a randomised, double-blinded, multicentre, placebo-controlled, clinical trial of aspirin in the management of VLUs. ASPiVLU will allow us to answer the question of whether daily active treatment with 300 mg aspirin improves time to healing of venous leg ulcers. Low-dose aspirin therapy may improve time to healing and decrease the number of recurrent VLU episodes. If proved effective, the low cost of aspirin therapy as an adjunct to compression would make it an affordable preventive agent for people with VLUs in all countries. […] […] Two other randomised trials investigating aspirin in people with venous leg ulcers are ongoing: the AVURT (Aspirin for Venous Ulcers: Randomised Trial NCT02333123) and the Aspirin4VLU (Low-Dose Aspirin for Venous Leg Ulcers NTC 02158806).

• #78 Health literacy in people with venous leg ulcers: a protocol for scoping review | BMJ Open

  https://bmjopen.bmj.com/content/11/5/e044604

  Venous leg ulcers (VLUs) are chronic skin ulcers mainly affecting the gaiter area, most often caused by continuous venous hypertension or chronic venous insufficiency. VLUs are a common health condition, affecting approximately 1%3% of people globally. The prevalence of VLU increases with age, doubling among those aged over 65 years. VLU healing, defined as complete wound re-epithelisation, is often slow. The chance of recurrence of a healed VLU is high. The cycle of healing and frequent recurrent episodes has significant economic impact and severely affects VLU patients health and well-being, including that of their families. Despite advances in treatments, sustained healing of VLU continues to be an ongoing problem for patients, health services and health systems. […] Current best practice recommendation for people with active VLU is the use of compression therapy unless the patient has arterial insufficiency, where it is contraindicated. Compression therapy promotes VLU healing by reducing the hydrostatic pressure in lower limbs, enhancing venous return and preventing venous stasis. Research suggests that the use of below-knee multi-component compression is efficacious and effective. Consistent compression therapy is recommended to prevent VLU recurrence. The best practice recommendations (exercise, compression) for treatment require significant patient involvement; however, patient adherence to the VLU management recommendations is often suboptimal.

• #79 Health literacy in people with venous leg ulcers: a protocol for scoping review | BMJ Open

  https://bmjopen.bmj.com/content/11/5/e044604

  Patient HL is defined as the ability to obtain, process and understand basic health information and services needed to make appropriate health decisions and follow instructions for treatment. There is a distinction between general health literacy (HL) often assessed through population-level surveys, and specific HL which deals with health skill and knowledge specific to the condition or disease. Both general and VLU-specific HL may affect VLU outcomes through affecting patients adoption of health behaviours. Improvements in general and specific HL may improve patient knowledge and understanding of the benefits of adhering to VLU self-management recommendations and support patients to adopt healthy behaviours in line with the agreed plan. […] Recent research has indicated that people vulnerable to VLUs, those with VLUs and those with other comorbidities tend to have concurrent deficits in HL. VLU incidence increases with age and older people have been shown to have limited general HL. A possible reason is internet usage. Though internet use is proportional to increased HL, current research consistently reports that older adults prefer to learn from their healthcare professionals, as opposed to independent learning through the use of the internet. Limited qualitative studies published in the past indicate that HL may affect VLU patients self-management capabilities, yet there have been no recent reviews published examining the level of HL of patients with VLUs, and the effect it has on patients adoption of health behaviours.

• #80 Health literacy in people with venous leg ulcers: a protocol for scoping review | BMJ Open

  https://bmjopen.bmj.com/content/11/5/e044604

  Given that HL in VLU patients appears less extensively researched than other factors in VLU healing, we opted to conduct a scoping review (ScR). The aim of this review is to scope the research examining the level of HL in VLU patients, and how this level may link to self-management behaviours (particularly exercise and compression adherence), and their VLU healing generally. Findings of this ScR will guide the development of clinical practice guidelines on instructing VLU patients according to their level of HL, as well as an assessment instrument for clinicians caring for VLU patients.

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