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Comparison of Costs and Healing Rates of Two Forms of Compression in Treating Venous Ulcers

Department of Surgery, University of Nevada School of Medicine, Reno, Nevada

Donna Kowallek, RN

Department of Surgery, Veterans Affairs Medical Center, Reno, Nevada

Richard K. Spence, MD, FACS

Staten Island University Hospital, Staten Island, New York

Joseph A. Caprini, MD, FACS

Department of Surgery, Northwestern University Medical School, Chicago, Illinois

Mark R. Nehler, MD

Department of Surgery, University of Colorado Health Sciences Center, Denver, Colorado

Jeffrey Jensen, DPM

Diabetic Foot and Wound Center, Denver, Colorado

Mitchel P. Goldman, MD

Department of Dermatology and Medicine, University of California, San Diego, La Jolla, California

Warner P. Bundens, MD

Department of Surgery, University of California, San Diego, La Jolla, California

The objective of this study was to compare healing rates and costs of treating venous ulcers with traditional Unna boots (UB) or a CircAid Thera-Boot (TB). A multicenter, prospective, randomized parallel-group study was performed in three university medical center vascular surgery clinics and three private medical offices. Patients presented with unilateral venous leg ulcers 5 cm or less in diameter. Patients with severe arterial, metabolic, or neuropathic diseases, and those who would not be expected to heal with conservative treatment, were excluded. Conservative treatment of the leg ulcer consisted of a nonadherent topical dressing and compression with either a traditional Unna's boot or a Thera-Boot. The main outcome measures were the following: time to healing, rate of area decrease, rate of percent area decrease, linear healing rate, costs of labor, materials, and overhead. Of 38 enrolled patients seven were withdrawn (five UB, two TB). Three patients were still in treatment when the study was stopped. Eleven UB patients and 17 TB patients completed the study. Healing rates were for UB and TB patients (mean (Meeting ± sd) were, respectively: time to healing (weeks) 9.69 ± 3.28, 7.98 ± 4.41 (p = 0.41), area healing rate (cm²/day) 0.0239 ± 0.0534, 0.0433 ± 0.0910 (p = 0.27),% area healing rate (%/day) 1.0493 ± 1.5583, 2.0357 ± 1.9520 (p = 0.56), and linear healing rate (cm/day), 0.0060 ± 0.0092, 0.0109 ± 0.0125 (p = 0.27). Costs for UB and TB (dollars to completion) were, respectively: clinician labor 331.37 ± 255.75, 201.91 ± 131.17 (p = 0.09), materials 160.86 ± 96.86, 122.79 ±27.59 (p= 0.14), overhead (number of visits) 11.70 ± 6.40, 6.71 ±3.77 (p = 0.02), and total costs 901.73 ± 576.45, 559.41 ±290.75 (p= 0.05).

Treatment of venous ulcers with Circ Aid Thera-Boots is significantly less costly than treatment with traditional Unna's boots. Trends toward faster healing were noted.

Vascular and Endovascular Surgery, Vol. 33, No. 6, 683-690 (1999)
DOI: 10.1177/153857449903300617


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