2012 Volume 16 Issue 3 Pages 257-267
The aims of this study were to qualitatively describe morphological characteristics of venous leg ulcers and to clarify the specific stages of wound healing for future development of an assessment tool with intervention items. Over a period of six months, nine patients with ten leg ulcers were recruited from a general hospital where a doctor specializing in venous diseases was available, and were followed longitudinally. A research nurse observed and assessed morphological characteristics of wounds, and created a code classifying the stages of wound healing. The obtained codes were qualitatively analyzed by the grounded theory approach. The results revealed five steps in the wound healing process for venous leg ulcers: the first step was <reduced venous stasis in the legs>; the second step combined <normalized periwound skin>, <beneficial change in the quantity and the quality of exudates> and <reduction of sticky fluid on wound surface>; the third step was <relief of edema in granulation tissue>; the fourth step combined <appearance of healthy granulation tissue> and <appearance of granulation tissue with different color> and the fifth step was <onset of the epithelialization> from the wound edge or wound bed. Especially, two novel characteristics were identified in venous leg ulcer healing: island-type epithelialization occurred in the pit and was surrounded by granulation tissue, and also in the brownish granulation tissue. Our observations suggested that a specific assessment tool is needed for venous leg ulcer healing because its wound healing process differs from that in other chronic wounds.