Transtibial amputees had accelerated healing times when fitted with a rigid dressing, compared with patients fit with a soft dressing, according to a recently published study.

“Advances in the engineering and application of prosthetics have made it possible for the majority of patients with a below-knee amputation to ambulate,” the researchers wrote. “An important priority should then be given to ensure timely healing of the below-knee amputation to achieve early ambulation.”

Soft vs. rigid dressings

Researchers performed a retrospective analysis on 151 patients who underwent transtibial amputation from 2000 to 2012, recording patient demographics, comorbidities and occurrence of complications of cellulitis or varying degrees of infection, including gangrene and osteomyelitis, and the type of postoperative dressing used. Ninety-one patients received a rigid plaster or plastic dressing and 60 patients received a soft gauze dressing with knee immobilizer. Researchers measured time between amputation and initial casting of the prosthesis.

Study results showed patients in the rigid dressing group had decreased healing time from amputation to initial casting vs. the soft dressing group. The rigid dressing group had a median healing time of 76 days, whereas the soft dressing group had a median healing time of 127 days. Researchers found 50% of patients treated with a rigid dressing were cast within 43 days vs. 75 days for patients treated with a soft dressing. More than 58% of patients who received a rigid dressing were cast after the first 60 days vs. 38% of patients who received a soft dressing.

“A greater percentage of patients placed in a rigid dressing were cast for a prosthesis after 2 months,” the researchers concluded. “Although there is a cost associated with rigid dressings, this is balanced by the quicker healing of the BKA [below-knee amputation]. Strong consideration should then be given to use of rigid dressings, preferably the prefabricated plastic dressings, in the postoperative application after a BKA.”

Dressing advantages, disadvantages

Although soft gauze dressing wraps are most commonly used and are easy to apply, they can cause complications, such as pressure damage and compromised distal blood flow when improperly applied. They also may become loose and fall off, exposing the suture site.

Labor intensive plaster dressings add time to the operating room procedure and are heavy for the patient to maneuver, as well as inconvenient to remove for inspection and management of the residual limb, according to the researchers. However, prefabricated plastic dressings have been developed during the last 20 years that come in a variety of sizes and are easy to remove and reapply, allowing frequent check of the incision and surrounding area for skin breakdown.

“There is no contraindication to using these prefabricated dressings, but, because of the ease of removal of the plastic dressing, care and diligence are needed in replacing the dressing immediately after inspection of the [residual limb],” the researchers wrote. “Although these dressings allow for the attachment of pylon and foot for immediate ambulation, this is not routinely implemented because of concerns for breakdown of the suture site. Furthermore, ambulatory dressings require use of a complicated strapping system that must be fastened properly to aid in proper suspension of the prosthesis and prevent injury to the distal limb.” — by Casey Murphy

For more information:
Sumpio B. Ann Vasc Surg. 2013;doi:10.1016/j.avsg.2013.03.007.

Disclosure: The researchers have no relevant financial disclosures.

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