A Novel Treatment Protocol to Improve Outcomes with Transtibial Amputations

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Category: Diabetes; Other Introduction/Purpose: A retrospective case series study was performed to evaluate the outcomes and risk factors of transtibial amputations (TTA) using a novel post operative treatment protocol. The study hypothesis is that a novel post operative treatment protocol could improve outcomes for TTAs. All patients who underwent a TTA from July 2019 through December 2022 were treated with this protocol. Outcomes identified included time to prosthetic fitting after surgery and complications including wound dehiscence and mortality at 30 days. Risk factors were also identified for the patients in this case series study. Methods: The novel post operative protocol includes a circumferential incisional negative pressure wound therapy (CiNPWT) dressing that covered with a novel residual limb shrinker (nRLS) and a limb protector (LP) applied after incision closure. The CiNPWT and nRLS were removed at the first follow up visit. Then the nRLS was applied as the primary dressing directly against the incision covering the residual limb. The nRLS was changed for wound cleansing and was sequentially decreased in size to facilitate consolidation of the residual limb. Results: There were 433 surgeries performed on 304 patients. This included 222 (73%) men and 81 (27%) women with an average age of 67 years (41-90 years). There were 129 revision surgeries including 25 above-the-knee amputations (AKA). The average time to prosthetic fitting for TTA was 8 weeks. The average study group BMI was 32 kg/m2, A1c 8.7%, albumin 2.6 g/dL and neutrophil to lymphocyte ratio (NLR) 4.9. Traumatic wound dehiscence from falls represented 26% of revision surgeries. Mortality at 30 days was 3.2% for all study participants. The early death average age was 70 years (41-90 years), 73% with end stage renal disease (ESRD) and 82% with diabetes mellitus (DM). Conclusion: The novel protocol for transtibial amputations decreased the 30 day mortality to 3.2% from a national average of 13.5%. The average time to prosthetic fitting was 8 weeks for the study group compared to 16 weeks for US Department of Veterans Affairs amputations. The early death group’s average albumin of 2.15 g/dL with a NLR of 8.9. The study demonstrated that a novel postoperative protocol may improve outcomes in transtibial amputations and that a few simple blood values may provide an indication of the diminished overall physiologic health of this patient population.