Effect of Superficial Venous Surgery on Venous Function in Chronic Venous Insufficiency

Evaluation of the introduction of the one-stop clinic and dedicated nurses for the ulcer cruris venosum care in the east of the Netherlands

Objective

In the Ziekenhuisgroep Twente Hospital, nurses from two community care organizations were trained to visit patients at home and provide adequate ulcer care. Furthermore, the one-stop clinic was introduced to set a diagnosis and treatment plan at the first visit in the hospital. The purpose of this study was to (a) evaluate if there is a difference in time to wound healing for patients with UCV treated by dedicated nurses compared to treatment by nurses in the Dermatology outpatient clinic and (b) determine if the one-stop clinic setting would lead to a difference in time to wound healing compared to the standard way of care.

Methods

In this retrospective cohort study, all files of patients with an ulcer in the Dermatology department of ZGT between 1 June 2010 and 1 June 2015 were studied.

Results

Out of a total of 385 new patients with an ulcer, 97 cases were included. Patients who were treated by dedicated nurses were significantly older ( p = 0.002) and had larger wounds ( p = 0.008). Age was not significantly related to time for wound closure (HR 0.99; 95% CI: 0.97–1.01, p = 0.226). After adjustment for confounders, there was no significant difference in time to wound closure between dedicated nurses (2.2 months (1.4–3.0)) versus hospital care (2.3 months (2.1–2.6)) (HR 1.01; 95% CI: 0.61–1.67, p = 0.961). The one-stop clinic led to a statistically shorter time to closure of the wound (1.8 versus 2.7 standard way of care, p = 0.007).

Conclusions

Time to wound closure is not statistically different between patients treated by dedicated nurses compared to hospital care when adjusted for the effects of the one-stop clinic. The one-stop clinic gives a significant better chance for faster time to wound closure controlled for both groups.

Leg ulceration: the importance of treating the underlying pathophysiology

The last 20 years have seen considerable advances in the management of vascular diseases both in non-invasive imaging and minimally invasive surgical interventions. Colour duplex ultrasonography provides non-invasive and increasingly high-resolution anatomic and haemodynamic vascular information. This has been complimented by the development of minimally invasive interventional procedures such as subintimal angioplasty and endovenous treatments, all of which can be performed under local anaesthesia. These advances can now be utilized to improve both the assessment and management of patients with chronic leg ulceration where the aetiology is usually vascular and mostly primary venous insufficiency. Using non-invasive Doppler pressures and colour duplex imaging, the anatomic and haemodynamic pattern of the underlying vascular disease (and consequently the pathophysiology) can be precisely determined. This enables appropriate planning and targeting of effective management from an early stage in the history of any particular ulcer. This paper highlights the importance of achieving accurate diagnosis and instituting effective treatments that are appropriately targeted at the underlying pathophysiology, in patients with chronic leg ulceration, and describes how recent advances in technology and interventions have substantially increased the tools available to the vascular specialist. Thus allowing safe and effective management of what can otherwise become a prolonged or recurrent disease process.