A Comparison of Rigid vs Soft Dressings in the Healing of Below Knee Amputations (BKA)

Abstract

Introduction and objectives: There is no standard protocol for the selection of surgical dressings after a below knee amputation (BKA). The purpose of this study was to compare rigid dressings with soft dressings on the healing times of BKA. We hypothesized that rigid dressings would facilitate faster wound healing and residual limb maturation by minimizing postsurgical edema and pain, preventing knee flexion contracture, and protecting the residual limb from trauma. Methods: Our retrospective analysis compared 151 patients who underwent BKA from 2000 to 2012 at Yale New Haven Hospital, after which 60 patients received soft dressings and knee immobilizers (soft) after the amputation, and 92 were placed in a rigid plastic or plaster prosthesis (rigid). Demographics and outcomes, including time between amputation and initial casting of prosthesis, were compared. Results: Age and diabetic status was not statistically different between the soft (61.0 years, 82.8% with diabetes) and rigid groups (58.6 years, 78.0% with diabetes). After BKA, the rigid dressing group demonstrated significantly decreased time spans from amputation to initial casting, as shown by the Fig (P .02 by log-rank and Wilcoxon test) and the Table. After 60 days, 58.24% of the rigid group was cast, compared with 38.33% of soft group (P .03 by t test). Conclusions: Use of a rigid dressing after a BKA significantly shortened the time to healing, as assessed by the time to casting. Use of a rigid prosthesis allows for consistent dressing changes of the healing BKA stump while facilitating inspection of the limb. Table. Days to casting