title: Early protection and compression of residual limbs may improve and accelerate prosthetic fit: a preliminary study.
abstract: BACKGROUND
  The goal of rehabilitation following lower extremity amputation is to restore the highest level of independent function. As much as possible, this includes the functional use of a prosthetic device fitted to the residual limb. Early prosthetic fit depends, in turn, on rapid healing of the amputation site.
  
  
  METHODS
  We hypothesized that compliance with a novel custom-designed amputation protection and compression system (CAPCS) to the residual limb can accelerate and improve the likelihood of successful prosthesis use. We conducted a retrospective study of all patients who were offered CAPCS by certified prosthetists (Hanger Prosthetics and Orthotics, Bethesda, MD) during the period between April 2004 and November 2009. Variables included age, sex, indication for amputation, and compliance with CAPCS. Compliance was defined as consistent observed wearing of the CAPCS as directed. The primary end point was the fitting of a prosthetic device to the amputated limb, with time to prosthetic fit being the secondary outcome.
  
  
  RESULTS
  Out of 100 patients who were offered CAPCS (n = 100) during the study period, 76% were considered compliant (n = 76). Sixty five patients (65%) were ultimately fitted with prosthetic limbs. In multivariate analysis, we found that patients who had compliant use of CAPCS were significantly more likely to be successfully fit with prosthesis (72 vs. 42%, p = 0.005). At 100 days post amputation, the cumulative incidence of prosthesis fitting was significantly higher in CAPCS compliant patients (69.7 vs. 22.2%, p = 0.012).
  
  
  CONCLUSIONS
  Compliant use of a CAPCS following amputation is associated with earlier and more frequent use of a prosthetic. Based on this limited data set, a conclusion can be drawn that the potential exists to significantly improve functional outcomes after amputation, but well-designed prospective studies are needed to confirm this association.
authors: Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
authors: Yazan
authors: Y
authors: Duwayri
authors: Raghuveer
authors: R
authors: Vallabhaneni
authors: John P
authors: JP
authors: Kirby
authors: Michael J
authors: MJ
authors: Mueller
authors: Oksana
authors: O
authors: Volshteyn
authors: Patrick J
authors: PJ
authors: Geraghty
authors: Gregorio A
authors: GA
authors: Sicard
authors: John A
authors: JA
authors: Curci
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000009:adverse effects; D001186:Artificial Limbs; D001458:Bandages; D016009:Chi-Square Distribution; D004867:Equipment Design; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D008923:Missouri; D015999:Multivariate Analysis; D016017:Odds Ratio; D010349:Patient Compliance; D010865:Pilot Projects; D011312:Pressure; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing