Ivana Vranjković Outpatient clinic for dermatology „Željko Pavičić, MD, PhD“, Zagreb Dubravko Huljev, MD, PhD CH „Sveti Duh“, Zagreb

1. VENOUS LEG ULCER-COST
BENEFIT OF MODERN
APPROACH TO HEALING
Ivana Vranjković
Outpatient clinic for dermatology
„Željko Pavičić, MD, PhD“, Zagreb
Dubravko Huljev, MD, PhD
CH „Sveti Duh“, Zagreb

2. ntroduction
There are several types of chronic wounds, but
most common chronic wounds are consequence of
venous insufficiency on the lower legs and the
amounts of total is about 75% of all chronic
wounds.

3. ntroduction
ost of the treatment
atient with venous ulcer
re not negligible. On the
vailable data from
ifferent country's they
ange from 1% to 3% total
und allocated for health
are.
o Expensive, long-term,
painstakingly and often
uncertain treatment is
still big, how in health
so and as social and

4. Methods
n this study the
verage duration of
lcers in continuity
was 4 years, and the
atients were treated
n several medical
nstitution, as well and
n primary care.
When the patients are
admited in hospital?

5. Methods
Locally we started with application supporting dressing
with Polyhexamethylene biguanide hydrochloride and
compression therapy.
Two weeks after, we include negative pressure wound
therapy in period of 9 days, to prepare wound bed for
surgical intervention.

6. Methods
er NPWT for next 4 days
re applied collagen dressing
order to further wound bed
nditioning.
hen the local and
crobiological wound status
s satisfying, the patients
re underwent to surgery.
cer were covered with thin
n graft (Thiersh mesh graft
:1) with immediately
plication of NPWT during
stoperative 5 days period.

7. Methods
Postoperative course was regular and graft was accepted in more than 95%.
After approximately two weeks of the initial surgery and rehabilitation of
donor region, the second procedure under local anesthesia, the binding of
the saphenous vein - inguinal crossectomy, was done.
Patients were dismissed from hospital with minimal residual defects which
healed in next 2-3 weeks.
During this period, on this residual defect were applied alginate dressings
and an elastic bandage.
The entire courses of treatment were photodocumentated, and wound
images processed in a special computer software WoundManagerTM in
order to verify the presence of types and quantities of tissues during
treatments before mesh graft covering.

8. Results
oto 1. Photo 2.
Photo 3.

9. Results
impossible accurately assess the
rent costs of 4 year treatment.
y the price of supporting
ssings were at least € 7,500 for
ent.
e include all parameters (gaze,
dages, solutions, medications
), then the overall cost of
uccessful treatment of these
ents certainly cost well in excess
he total amount of 33,000 €.
 The cost of hospital (hospital days,
surgical procedures and
medications) was € 3,766.16.
 The cost of consumables
(supportive wound dressings,
NPWT, set for compression therapy
etc.) was € 2,459.71.
 Total material cost of treatment,
from initial examination to healed
ulcers, was € 6,225.87 for all three
patients.
cost of unsuccessful treatment: The cost of method we use:

10. Conclusion
In this example of a complex, multidisciplinary
approach to patients with chronic venous leg
ulcer, based on the latest knowledge about
treatment options, it has been proved that is
possible to significantly reduce the time and the
cost of treatment, and consequently, reduce the
number of patients with chronic venous ulcers.