title: A novel approach to wound management and prosthetic use with concurrent vacuum-assisted closure therapy.
abstract: OBJECTIVE
  Stump healing is critical to post amputation management. When healing is not optimal, immobility is prolonged and patients risk hospital acquired deconditioning. Two clinical cases with unhealed trans-femoral stump wounds are described. Vacuum assisted closure (VAC) dressing with concurrent prosthetic utilisation was undertaken successfully in both cases.
  
  
  METHODS
  Fitting of the prosthetic socket included space for VAC dressing with modifications to allow the suction piping to exit the prosthesis. With VAC application, timely rehabilitation and mobility was enabled despite incomplete wound healing.
  
  
  CONCLUSIONS
  The two clinical cases described made excellent progress. Discharge home was expedited with the provision of portable VAC pumps. Wounds healed fully without infection. Both patients were able to mobilise sooner than if they had to wait for complete wound closure and, importantly, the consequences of prolonged immobility were minimised. No extra costs were incurred using this novel therapy.
  
  
  CONCLUSIONS
  Guidance for early mobilisation of trans-femoral amputees with open wounds is limited. These cases provide examples utilising VAC dressings with concurrent prosthetic rehabilitation, facilitating prompt ambulatory retraining, minimising deconditioning and optimising outcomes.
authors.affiliation: Prosthetic Physiotherapy Department, Southwark PCT, Bowley Close Rehabilitation Centre, London, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Fuller
authors.forename: Robin
authors.initials: R
authors.lastname: Luff
authors.forename: Monique
authors.initials: M
authors.lastname: Van Den Boom
mesh_terms: D000328:Adult; D000674:Amputees / Q000523:psychology / Q000534:rehabilitation; D001186:Artificial Limbs; D003362:Cost-Benefit Analysis; D005260:Female; D005269:Femur / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D013977:Tibia / Q000601:surgery; D016896:Treatment Outcome; D058106:Wound Closure Techniques / Q000191:economics / Q000295:instrumentation; D014945:Wound Healing / Q000502:physiology*