Development of a severity scale for evaluating the need for Graftskin in nonhealing venous ulcers.
OBJECTIVE: To construct an easy-to-use severity scale based on data from a multicenter venous leg ulcer trial to predict which wounds will progress toward closure and which will remain unhealed. DESIGN: Factors that have an impact on wound healing (eg, ulcer duration, depth, area, location, and fibrin) were identified in the literature. A severity scale was constructed based on these factors. SETTING: Multicenter clinical trial. PATIENTS: 240 patients with venous leg ulcers of longer than 1 month's duration. MAIN RESULTS: Wound duration and area were identified as having the greatest impact on ulcer healing. Using multivariate regression analyses, a wound score of 8 or less was considered mild to moderate. A severe wound, having a score of 9 or greater, was found to be unlikely to heal with compression therapy alone. CONCLUSION: This severity scale can serve as an adjunctive tool in the prompt identification of ulcers with a poor healing prognosis and enable early intervention with alternate therapies. To optimize the severity scale, future trials should incorporate a method to review the interaction of known factors that impair wound healing.