A randomised trial of rigid stump dressing following trans-tibial amputation for peripheral arterial insufficiency.
BACKGROUND
A multicentre randomised controlled trial to determine the effect of a rigid plaster dressing applied at the time of trans-tibial amputation on the number of days to casting for a prosthesis, and the incidence of post-operative stump infection.


METHODS
Patients requiring trans-tibial amputation were randomised to one of 2 groups: In Group 1 (intervention) a rigid above-knee plaster dressing was applied at operation and patients were managed according to a standard protocol. Group 2 (control) had the individual surgeons' usual non-rigid dressing regime. Rehabilitation data were extracted from the national physiotherapy database. On completion of the trial a questionnaire was sent to all participants.


RESULTS
14 surgeons in 7 centres enrolled 154 patients, with 96 ultimately cast for a prosthesis. Patients who received a rigid dressing (n = 78) had reduced days to casting (median 36, confidence interval 30-47) when compared with other dressings (n = 76) (median 42, confidence interval 36-45), these differences did not reach statistical significance. There was no significant difference in post-operative infection rates in the two groups. 64% of surgeons, and all physiotherapists and vascular nurses responding to the post-trial questionnaire felt that the rigid dressing was an improvement on their normal regime and wished to continue with the technique.


CONCLUSIONS
Despite a median reduction of 6 days in time to casting in patients treated with a rigid post-operative dressing this failed to reach statistical significance. The majority of participants who replied to the post-trial questionnaire expressed a wish to continue using the rigid dressing technique. To confirm that the trends shown in this trial are statistically valid a larger trial is needed.
Woodburn
K R
KR
Vascular Surgery Unit, Royal Comwall Hospital, Truro TR 1 3LJ, Cornwall, England, UK. ken.woodburn@rcht.cornwall.nhs.uk
Sockalingham
S
S
Gilmore
H
H
Condie
M E
ME
Ruckley
C V
CV
D000671:Amputation, Surgical; D000672:Amputation Stumps; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D001458:Bandages; D002133:Calcium Sulfate; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007866:Leg / Q000601:surgery*; D008297:Male; D013977:Tibia
D002133:Calcium Sulfate