Achieving and Maintaining Treatment Adherence in Refractory Leg Ulcers

Achieving and maintaining treatment adherence, which emphasizes active patient involvement, is a key factor influencing wound healing outcomes in the treatment of refractory leg ulcers.However, adherence is often hindered by pain, low awareness of the disease, and psychosocial barriers.The critical elements for fostering adherence include a multifaceted approach involving patient education, pain management, treatment simplification, multidisciplinary collaboration, and social support.We herein report a 61-year-old woman with a 13-year history of bilateral venous leg ulcers who refused cleaning and hospital treatment due to severe pain and distrust of medical care.Her condition worsened, leading to emergency hospitalization for ulcer bleeding.Upon admission, multidisciplinary treatment was initiated with pain control through epidural blocks, followed by repeated ultrasonic debridement.As the ulcers improved and pain subsided, the patient's attitude shifted, and she began learning wound care techniques and eventually continued self-care after discharge.To support adherence, we implemented individualized education using behavioral change models (Fink's model, transtheoretical model, and COM-B model), simplified the treatment regimen, and collaborated with a home-based care team and local clinics.These interventions lead to sustained adherence and progressive wound healing.This case illustrates that establishing and maintaining adherence require a multifactorial, dynamic approach tailored to each patient's evolving physical, psychological, and social needs.Adherence not only facilitates wound healing but also enables the early detection of disease transitions.Continuous empathetic support and flexible care systems are essential for improving long-term outcomes in patients with refractory ulcers.