Manage Residual Limb Wound Care With Elevated Vacuum

LAS VEGAS – Prolonged wound healing at the residual limb for the transtibial amputee increases the cost of care, slows the rehabilitation process and decreases daily living activities, according to Rob Hoskins, CP. However, elevated vacuum for wound healing presents a valuable clinical application in the rehabilitation process.

“Elevated vacuum sockets can be used to manage wounds without interruption of the rehabilitation process and they provide an environment that is conducive to wound healing,” he said at the 2011 American Orthotic and Prosthetic Association National Assembly here.

Hoskins said that historically, patients with sores and open wounds at the residual limb are advised by their physician not to wear their prosthesis, increasing the risk of falls, decreasing overall function of the patient and possibly interrupting their fitting process. But one technique that manages the wound while allowing the patient to continue wearing his or her prosthesis, is the use of an elevated vacuum socket.

“Two of the crucial elements of this method are education of the patient and the referring physician, as well as follow-up and compliance from the patient,” Hoskins said.

Recent studies suggest elevated vacuum is a possible clinical application for transtibial amputees in need of wound care, according to Hoskins. He cited studies which indicated elevated vacuum prevents volume loss and in some cases caused slight volume increases. Elevated vacuum can also reduce skin issues due to providing a more comfortable fit for the patient, suggesting elevated vacuum is conducive to wound healing.

For his case study, Hoskins managed the wounds with elevated vacuum of three patients with a mean age of 65. He tracked their wound service area using free software developed by the National Institute of Health. Hoskins tracked the wound service area until the wounds closed.

“Using elevated vacuum for wound healing is not all that new,” Hoskins said. “People have been using elevated vacuum to manage wounds for a while now. But there is a lack of numerical data indicating wounds can be managed and healed while the patient makes full use of their prosthesis.”

The image analysis was completed using open source software for image calculation of the wound service area. Hoskins said that practitioners can collect data from a wound service area with just a digital camera and a ruler or tape measure.

In his study, the wounds of his three patients healed over time, while they all continued to use of their prosthesis.

Hoskins R. Case study: Utilizing elevated vacuum to manage wound care in transtibial amputees. Presented at the 2011 American Orthotic & Prosthetic Association National Assembly. Sept. 19-22. Las Vegas.

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