Short summary

This project aims to investigate predictors for long-term wound care, amputation and / or death respectively, among patients referred to specialist treatment for leg wounds, and to describe regional differences in Denmark in incidens and prevalence of long-term wound care, amputation and /or death respectively.

Rationale

It has been estimated that 1.51 per 1000 population have a chronic leg wound (leg or foot wound not healed within six weeks(1)) from all etiologies(2). Among the diabetic population it has been suggested that 15-25% will have a foot wound at some point (3), of which 66% will heal within 12 months. Meantime for healing has been found to be 78days (ibid).  However, 17% will die and 11% will have a leg amputated within 12 months from first appearence. Moreover will 50% have a new wound within three years. 

Leg wounds that do not heal spontaneously, may have several causes, where the most common are infection, venous insufficiency and ischemia; often in combination (1). Critical ischemia in the legs due to peripheral arterial disease (PAD) is suggested as a contributing factor to the absence of wound healing in 30-40% of cases (4). Thirty percent of patients diagnosed with this advanced stage of PAD will have a leg amputated within one year, and 25% will die (1). In the western world, most amputations (>90%) are necessitated by complications associated with vascular disease and the majority have a history of chronic wounds (5). In Denmark, approximately 1800 patients have a major amputation (amputation at tibia, knee or femoral level) every year (6). The mean age of the affected patients are 70 years and multi-comorbidity is prevalent with diagnosis of cardiovascular diseases, COLD and diabetes being the most frequent(6).

Living with a chronic leg wound affects all aspects of quality of life (7,8)and everyday life is determined by the problems the wound causes (9,10). Treatment comprises in addition to frequent wound dressings and surgery: antibiotics, compression, and if possible, vascular surgical interventions. However, it is not clear what characterizes patients who end up with long-term wound treatment, amputation and / or early death, and there is a need to investigate this further to be able to identify the patients in need of palliation and rehabilitation.

Description of the cohort

Patients will be included on their first referral to a hospital (inpatient or out patient clinic) for leg wounds from 2007-2012, and will be observed for a minimum of 5 years each. Patients with an open contact for more than six weeks, will be included as having a chronic wound.

Data and biological material

Register data

Collaborating researchers and departments

Ortopedic Department, Holbaek Hospital

• Physician, Arash Khoei