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.
While the importance of preventive care for diabetic foot ulcer（DFU）is recognized, there have been no reports to our knowledge detailing the specific preventive measures needed in Japan. Therefore, in this study we investigated neuropathy, angiopathy, foot deformity, history of DFU, non-ulcerative pathology and subjective symptoms in 579 diabetes patients who visited the diabetes department of a university hospital from September 2007 to March 2008. Risk was categorized based on the International Consensus on the diabetic foot, and patients’ preventive care needs such as regular inspection and examination, education, footwear, and treatment of non-ulcerative pathology were evaluated. The consultation rate at the Outpatient Foot Clinic and incidence of DFU were calculated from their medical records. The patients' risk categories were: 0（regular inspection and examination: once a year）, 72.5%; 1（once every 6 months）, 21.3%; 2（once every 3 months）, 5.7%; and 3（every month）, 0.5%. Adaptations for education, footwear, and treatment of non-ulcerative pathology were needed in 6.2%, 31.8%, and 3.6%, respectively. The rate of consultation at the Outpatient Foot Clinic was 16% and the incidence of DFU after 36 months was 0.6%. The prevalence of tinea infection erosion was 18.5%, 15.7% had calluses, 14.4% showed dryness and 52.3% experienced cramping. Among the patients with dryness/cracking as assessed by a healthcare provider, only 45.0% were aware of their symptom. Our results suggested that preventive care for DFU in Japan might be insufficient, because the consultation rate at the Outpatient Foot Clinic was low. More inspections by healthcare providers and preventive care for tinea infection, calluses and dryness are needed.