Abstract:

Background: Chronic lower limb ulcers constitute a major public health problem great important all over the world and contribute significantly to high morbidity and long-term disabilities. There is paucity of information regarding chronic lower limb ulcers in our setting; therefore it was necessary to conduct this study to establish the patterns and outcome of chronic lower limb ulcers and to identify predictors of outcome of CLLUs in our local setting.

Methods: This was a perspective cross-sectional study of patients with chronic lower limb ulcers over 17 month’s period between November 2010 and April 2012. Statistical data analysis was done using SPSS version 17.0 and STATA version 11.0. The inclusion criteria were; all patients of all age groups and gender presenting with CLLUs and patients who consented for the study. The exclusion criteria were; patients who refused to consent for HIV testing and who were three months, patients who refused investigation, patients who refused treatment.

Results: A total of 300 patients with CLLUs were included in the study. Their ages ranged from 3 months to 85 years (median 32 years). The male to female ratio was 2:1. The median duration of illness was 44 days. Traumatic ulcer was the most frequent type of ulcer accounting for 60.3% of patients. The leg was commonly affected in 33.7% of cases and the right side (48.7%) was frequently involved. Out of 300 patients, 212 (70.7%) had positive aerobic bacterial growth within 48 hours of incubation. Pseudomonas aeruginosa (25.5%) was the most frequent gram negative bacteria isolated, whereas gram positive bacteria commonly isolated was Staphylococcus aureus (13.7%). Fungal infection was not investigated. Twenty (6.7%) patients were HIV positive with a median CD4+ count of 350 cells/µl. Bony involvement was radiologically reported in 83.0% of cases. Histopathological performed in 56 patients revealed malignancy in 20 (35.7%) patients, of which malignant melanoma (45.0%) was the most common histopathological type. The vast majority of patients, 270 (90.0%) were treated surgically, and surgical debridement was the most common surgical procedure performed in 24.1% of cases. Limb amputation rate was 8.7%. Post treatment complication rate was 58.3% of which surgical site infection (77.5%) was the most common post-treatment complications. The median length of hospital stay was 23 days. Mortality rate was 4.3%. Our of the two hundred and eighty-seven (95.7%) survivors, 253 (91.6%) were treated successfully and discharged. After discharge, only 35.5% of cases were available for follow up at the end of study period.

Conclusion: Chronic lower limb ulcers resulting from road traffic accidents (RTAs) remain a major public health problem in this part of Tanzania. Urgent preventive measures targeting at reducing the occurrence of RTAs is necessary to reduce the incidence of chronic lower limb ulcers in this region.