Wound Healing Complications Associated with Lower Limb Amputation

1
Wound Healing Complications Associated with Lower
Limb Amputation

• Literature Review

2
Lower Limb Amputation (LLA)

• LLAs account for the majority of all amputations
  in Australia, the UK and the US
• Peripheral vascular disease and diabetes are a
  major cause of lower limb amputation
• Approximately 85-90 of lower limb amputations in
  the developed world are caused by peripheral
  vascular disease
• Murphy (2006)

3
Morbidity Mortality

• 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

4
Morbidity Mortality

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

5
Infection

• 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

6
Treatment

• 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

7
Treatment

• 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