Rapid mobilization after amputation reduces risk of reamputation in elderly patients

LEIPZIG, Germany — Getting elderly amputees mobilized shortly after amputation surgery speeds healing and reduces the risk for reamputation, according to results from two case studies presented at the OT World Congress, here.

Anton Johannesson

Anton Johannesson, PhD, OTAB Ortopedteknik AB, Kristianstad, Sweden, described a postsurgical method in which the sagittal incision is covered with a rigid wound dressing followed by compression with a silicone liner 1 week after amputation. The patients start to walk as soon as possible to enhance blood circulation in the residual limb.

“We want to mobilize the patient by using a semi-hydrostatic prosthetic socket to enhance the circulation, and by having them walking and getting positive and negative pressure in the socket,” he said.

Some patients experience delayed wound healing. Johannesson said there is no established treatment protocol for those patients, particularly for elderly patients.

“The alternative is a wait-and-see strategy,” he said, in which the wound must heal before the patient walks. “What we should not be doing is being inactive with these patients. In many cases, all efforts are a better alternative than reamputation to a higher [transfemoral] level,” he said.  “So we take the risk.”

He presented a case study of a 91-year-old man who had an ongoing surgical wound. The patient had the option of getting a higher level reamputation, but chose to stay at the transtibial level.

“Fourteen days [after surgery] the wound didn’t look good. We didn’t know how bad it was below the surface. Then 4 weeks later, we saw changes around the edges, signs of better blood flow. Two days prior to prosthetic fitting, 4½ weeks after amputation, the wound showed improving signs of healing,” Johannesson said.

Finally, 7 weeks after amputation, the patient was walking with a prosthesis. “If he had gone for the transfemoral level, he would have never mobilized that way.”

In a second case study, Johannesson said the patient had a double knee replacement.

“You can’t use a traditional amputation technique,” he said. “You try to save whatever you can save.”

The edema long the suture line decreased after 5 days of using a compression liner. The patient had some remaining contracture, but otherwise the wound healed well, he said. The patient was walking well with a prosthesis 11 weeks after surgery.

“We have been doing this kind of work for 16 years now, with all types of stumps, mobilizing instead of waiting, and I think that is absolutely the key issue.” — by Carey Cowles

For more information:

Johannesson A. Prosthetic fitting of elderly new amputees with wound healing issues. Presented at: OT World Congress;. May 12-16, 2014; Leipzig, Germany.

Disclosure: Johannesson has no relevant financial disclosures.

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