Comparison of vacuum-formed removable rigid dressing with conventional rigid dressing after transtibial amputation: similar outcome in a randomized controlled trial involving 27 patients.
OBJECTIVE
Following transtibial amputation, a rigid dressing of plaster of Paris has been reported to have advantages over a soft dressing regarding wound healing and reduction of edema, but use of the former may be limited by difficulties in application and in gaining access to the wound. An easily applicable and removable vacuum-formed rigid dressing (ORD) has recently been introduced. We compared the ORD with a conventional rigid plaster of Paris dressing with regard to wound healing, time to fitting of a prosthesis, and function with the prosthesis.


METHODS
Patients undergoing transtibial amputation for peripheral vascular disease were randomized at surgery to receive ORD (O) or conventional rigid dressing (C) for 5 to 7 days, followed by compression therapy using silicone liner. The primary outcome measure was time to prosthetic fitting and secondary outcome measures included function with the prosthesis 3 months after amputation, measured with the Locomotor Capability Index (LCI) and the Timed "Up and Go" (TUG) test. All patients received prostheses with a total surface-bearing socket.


RESULTS
Of 27 patients randomized to one or other dressing (15 O and 12 C), prosthetic fitting was achieved in 23 patients (mean age 76 (43-91) years; 13 (9 men) in the O group and 10 (5 men) in the C group). Wound healing was similar in both groups. Mean time to prosthetic fitting was 37 (26-54) days in the O group and 34 (21-47) days in the C group (adjusted mean difference 3, 95% CI: -3-9). At 3 months, mean LCI was 28 (6-42) in the O group and 25 (2-41) in the C group (mean difference -0.1, 95% CI: -8.5-8.2). Mean TUG was 41 (10-92) seconds and 29 (10-47) seconds, respectively (mean difference 14, 95% CI:-2-30).


CONCLUSIONS
The vacuum-formed rigid dressing appears to give results similar to those of the conventional rigid dressing regarding time to prosthetic fitting and patient's function with prosthesis.
Johannesson
Anton
A
Department of Clinical Sciences, Lund University, Lund, Sweden. aj.otab@telia.com
Larsson
Gert-Uno
GU
Oberg
Tommy
T
Atroshi
Isam
I
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000672:Amputation Stumps; D001186:Artificial Limbs; D001458:Bandages; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017755:Prosthesis Fitting; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome; D014945:Wound Healing