Highlights
- •Rigid dressing shields the residual limb and improves healing after amputation.
- •Patients who receive a rigid dressing need less pain medications at discharge.
- •Patients who receive a rigid dressing have higher rates of ambulation at follow-up.
- •Removable rigid dressings are clinically useful to improve outcomes postamputation.
Background
Lower extremity amputations are often associated with limited postoperative functionality
and postoperative complications. Removable rigid dressings (RRDs) have been used following
below-knee amputation (BKA) to improve limb maturation, decrease postoperative complications,
reduce time to prosthesis casting, and limit conversion rates to above-knee amputation
(AKA). We hypothesized that usage of RRD following BKA will correlate with decreased
prescription narcotics required at discharge and improved ambulatory status at follow-up.
Methods
A retrospective chart review was conducted to identify all patients who underwent
BKA performed by the vascular surgery service at a large, acute care hospital between
July 2016 and July 2021. Data collected included age, sex, body mass index, conversion
to AKA, narcotic prescriptions at discharge, and ambulatory status at follow-up.
Results
Between July 2016 and 2021, rate of conversion to AKA was significantly lower in patients
who received an RRD (9.3%), as opposed to those who did not (41.5%) (P = 0.0002). Narcotic prescriptions at discharge, compared following conversion to
morphine equivalents, were also significantly lower in the rigid dressing group compared
to patients who did not receive the dressing (50.5 vs. 108.9 morphine eq/24 h, P = 0.0019). Furthermore, use of rigid dressing significantly improved ambulatory status
at follow-up to 75.9% in RRD patients compared to 29.3% in patients with conventional
dressing (P < 0.0001). This statistical significance persisted after all patients who were converted
to AKA were removed from analysis (79.6% vs. 39.3% ambulatory, P = 0.000363). Multivariate analysis revealed that ambulatory status at follow-up was
only associated with age more than 80 years (P = 0.042) and use of postoperative RRD (P = 0.001).
Conclusions
These findings support the utility of an RRD following BKA to reduce conversion to
AKA, reduce narcotic dosages required at discharge, and improve ambulatory status
at follow-up.
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Article info
Publication history
Published online: December 04, 2022
Accepted:
November 4,
2022
Received:
August 12,
2022
Footnotes
None of the authors have conflicts of interest or financial disclosures.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
