Wound Healing Complications Associated with Lower Limb Amputation

Wound Healing Complications Associated with Lower Limb Amputation Literature Review

Lower Limb Amputation (LLA) LLA’s account for the majority of all amputations in Australia, the UK and the US l Peripheral vascular disease and diabetes are a major cause of lower limb amputation l Approximately 85 -90% of lower limb amputations in the developed world are caused by peripheral vascular disease Murphy (2006) l

Morbidity & Mortality l l l Major lower extremity amputations are still associated with considerable morbidity and mortality – Ploeg et al (2005), Leung et al (2004) De Godoy et al (2005) – high mortality rate Peng & Tan (2000) – 19% infection 8% revision

Morbidity & Mortality l Potential wound-healing complications include infections, tissue necrosis, pain, problems associated with the surrounding skin, bone erosion, haematoma, residual limb oedema and dehiscence

Infection l l l Can pose serious complications for the amputee (Murphy 2006) Murphy et al (2001) – MRSA linked to high mortality, surgical revision and debridement Richards et al (2005) – MRSA infection has a poor prognosis, prophylaxis may be effective

Treatment l l Armstrong & Lavery (2005) RCT of 162 patients NPWT versus standard moist wound care More patients healed with NPWT and faster Greenberg et al Single case study – 6 month old girl Tissue-engineer skin applied to chronic wound in non-healing amputation stump

Treatment l l Dalla et al (2003) Use of follow-up program decreased re-ulceration & re-amputation in diabetic post-op patients Vigier et al (1999) RCT of two groups of 28 subjects Plaster cast socket with silicone sleeve versus elastic compression bandages Plaster socket led to increased healing and decreased hospital stay