Post-amputation Wounds Research Articles

Critical factors leading to wound complications in amputated patients: low hematocrit levels

Background: Patients with diabetes-induced lower extremity infection and gangrene suffer from post-amputation wound complications. The aim of this report is to identify critical factors leading to wound complications in amputated patients.Methods: 50 patients with ipsilateral transmetatarsal (TMA) or finger amputation treated in Istanbul University Medical Faculty between 2001 and 2013 were retrospectively reviewed. Amputations were caused by diabetic foot infection. None of the patients had peripheral artery disease (ABPI>1.1).Results: In 9 (18%) patients, revision was required despite appropriate antibiotherapy after amputation. 7 (78%) of these patients were women, 8 (89%) were smokers and hematocrit levels were below 25% in all of them. 4 of the 5 patients (80%) with chronic kidney disease were among the patients in need of revision.Conclusion: The risk of wound complications after amputation is high. These complications increase morbidity and treatment costs. This study showed that low hematocrit value is a risk factor for the development of wound infection after amputation.

Machine Learning Analysis of Multispectral Imaging and Clinical Risk Factors to Predict Amputation Wound Healing

Machine Learning Analysis of Multispectral Imaging and Clinical Risk Factors to Predict Amputation Wound Healing

Struggling for normality: experiences of patients with diabetic lower extremity amputations and post-amputation wounds in primary care.

To explore the experiences of patients living with diabetic lower extremity amputation (DLEA) and its post-amputation wound in primary care. DLEA, including both minor and major amputation, is a life-altering condition that brings numerous challenges to an individual's life. Post-amputation physical wound healing is complicated and challenging because of wound dehiscence and prolonged healing times. Understanding patients' experiences after DLEA with a post-amputation wound will enable healthcare professionals to develop interventions to assist patients in physical healing and psychosocial recovery. This study employs a qualitative design using interpretative phenomenological analysis (IPA). A purposive maximum variation sample of nine patients who had had lower extremity amputations and post-amputation wound attributed to diabetes in the previous 12 months was recruited from a primary care setting in Singapore. Semi-structured audio recorded one-to-one interviews with a duration of 45-60 min each were conducted between September 2018 and January 2019. The interviews were transcribed verbatim and analysed using IPA. The essential meaning of the phenomenon 'the lived experiences for patients with DLEA and post-amputated wound' can be interpreted as 'struggling for "normality"' which encompasses four domains of sense making: physical loss disrupted normality, emotional impact aggravated the disrupted normality, social challenges further provoked the disrupted normality, and attempt to regain normality. The study highlights the complex physical and psychosocial transition facing patients after DLEA before post-amputation wound closure. In primary care, an amputation, whether minor or major, is a life-altering experience that requires physical healing, emotional recovery, and social adaptation to regain normality. Patients living with DLEA and a post-amputation wound may benefit from an interdisciplinary team care model to assist them with physical and psychosocial adjustment and resume normality.

Negative pressure wound therapy for treating foot wounds in people with diabetes mellitus.

Negative pressure wound therapy for treating foot wounds in people with diabetes mellitus.

Clinical experience of a new NPWT system in diabetic foot ulcers and post-amputation wounds

The primary aim of this pilot observational study was to assess the reduction in wound depth and area achieved with a new negative pressure wound therapy (NPWT) system in diabetic patients with foot ulcers and post-amputation wounds. Secondary aims were to assess pain levels, extent of exudate removal, and ease of use of the system for both the patient and care giver. Patients in both acute and home care settings were enrolled into this 4-week study. Dressings were changed three times per week. Wound area and depth, exudate removal and pain severity were evaluated at each dressing change. At the final visit, the investigators and patients were surveyed with respect to equipment and dressings used in the study. Sixteen patients were enrolled into the study. Data relating to 14 patients with a variety of post-amputation wounds were included in the intention-to-treat (ITT) analysis. The post-amputation wounds showed a general trend for a reduction in the median wound surface area between baseline (22.9cm2; range 0.5-55) and the final visit (15.3cm2; range 2.4-63.5). This equates to a median change (calculated from the percentage change in wound area for each patient individually) of -41% (range -82% to +15%). There was also a general trend in reduction in the median depth between baseline (17mm; range 0-35) to final visit (5mm; range 0-35). One patient presented with a foot ulcer that demonstrated a 50% reduction in depth from baseline to the final assessment. The device effectively managed wound exudate and most patients reported low pain levels during therapy. Ease of use of the system was rated very highly by investigators and patients. This pilot study indicates that the use of the new NPWT system can be expected to have a positive effect on the healing of post-amputation wounds and foot ulcers in patients with diabetes. The findings demonstrate that the system is easy to use, effectively controls exudate and minimises pain and inconvenience for patients being treated with NPWT. This study was sponsored by Mölnlycke Heath Care (Gothenburg, Sweden) and Medela AG (Baar, Switzerland). The authors have no other conflicts of interest that are directly relevant to the content of this manuscript.

Clinical experience of a new NPWT system in diabetic foot ulcers and post-amputation wounds

Objective: The primary aim of this pilot observational study was to assess the reduction in wound depth and area achieved with a new negative pressure wound therapy (NPWT) system in diabetic patients with foot ulcers and post-amputation wounds. Secondary aims were to assess pain levels, extent of exudate removal, and ease of use of the system for both the patient and care giver. Method: Patients in both acute and home care settings were enrolled into this 4-week study. Dressings were changed three times per week. Wound area and depth, exudate removal and pain severity were evaluated at each dressing change. At the final visit, the investigators and patients were surveyed with respect to equipment and dressings used in the study. Results: Sixteen patients were enrolled into the study. Data relating to 14 patients with a variety of post-amputation wounds were included in the intention-to-treat (ITT) analysis. The post-amputation wounds showed a general trend for a reduction in the median wound surface area between baseline (22.9cm2; range 0.5-55) and the final visit (15.3cm2; range 2.4-63.5). This equates to a median change (calculated from the percentage change in wound area for each patient individually) of -41% (range -82% to +15%). There was also a general trend in reduction in the median depth between baseline (17mm; range 0-35) to final visit (5mm; range 0-35). One patient presented with a foot ulcer that demonstrated a 50% reduction in depth from baseline to the final assessment. The device effectively managed wound exudate and most patients reported low pain levels during therapy. Ease of use of the system was rated very highly by investigators and patients. Conclusion: This pilot study indicates that the use of the new NPWT system can be expected to have a positive effect on the healing of post-amputation wounds and foot ulcers in patients with diabetes. The findings demonstrate that the system is easy to use, effectively controls exudate and minimises pain and inconvenience for patients being treated with NPWT. Declaration of interest: This study was sponsored by Mölnlycke Heath Care (Gothenburg, Sweden) and Medela AG (Baar, Switzerland). The authors have no other conflicts of interest that are directly relevant to the content of this manuscript.

Resource Utilization and Economic Costs of Care Based on A Randomized Trial of Vacuum-Assisted Closure Therapy in the Treatment of Diabetic Foot Wounds

Conclusion: In diabetic patients with post-amputation wounds, negative pressure wound therapy heals a greater proportion of patients with less resource utilization than standard moist wound therapy. Summary: There were 162 patients with diabetes and post-amputation wounds entered into a 16 week randomized clinical trial. Seventy-seven patients were randomized to negative pressure wound therapy NPWT) and received dressing changes every 48 hours. Eighty-five patients received standard moist wound (MWT) therapy according to consensus guidelines (Wound Ostemy Continence Nursing Society. Guideline for Management of Wounds in Patients with Lower Extremity Neuropathic Disease. WOCN Glennville, IL; 2004: 57). Direct costs, procedures, and resource utilization were analyzed in a post-op retrospective analysis. In the NPWT v. MWT groups, there were no differences in inpatient hospital stay either in terms of number of admissions or length of stay. There were more debridement procedures required in the MWT group (120 v. 43, p<0.001). The average number of dressing changes per patient in the MWT group was 118 (range 12-226) v. 41 (6-140) for NPWT, p=0.0001. The average direct cost per patient for 8 weeks of treatment or longer was $27,220 for the NPWT group and $36,096 for the MWT group. The average total cost to achieve healing was $25,954 in patients treated with NPWT (n=43) compared with $38,806 for the MWT group (n=33). Comment: It is very expensive to heal wounds. The study suggests negative pressure therapy for open diabetic wounds is cheaper and more effective than standard moist wound therapy. Costs in the MWT group were driven primarily by dressing changes and antibiotic costs. It is likely that the costs presented are conservative. Costs related to transportation, inpatient dressing changes, prosthesis and rehabilitation were not included in the analysis. Note the authors have affiliations with KCI, the manufacturer of the negative pressure device used in this study.

A systematic review of the effectiveness of negative pressure wound therapy in the management of diabetes foot ulcers

Foot ulcers are a common complication in patients with diabetes. Negative pressure wound therapy (NPWT) is a wound care therapy that is being increasingly used in the management of foot ulcers. This article presents a systematic review examining the effectiveness of this therapy. The review question is how effective is NPWT in achieving wound healing in diabetes foot ulcers? The primary outcome for this study was the number of patients achieving complete wound healing (secondary outcomes, other markers of wound healing, adverse events and patient satisfaction). A systematic literature review and tabulative synthesis of randomised controlled trials (RCTs). The review identified four RCTs of weak to moderate quality. Only one study examining NPWT in postamputation wound healing reported data on the primary outcome. These data show a 20% improvement in wound healing [odds ratios = 2.0%, confidence interval (CI) -1.0 to 4.0] and number needed to treat = 6 (CI 4-64). No serious treatment-related complications were reported by any of the studies. One study suggested a reduction in the risk of secondary amputation (absolute risk reduction = 7.9%, CI 0.5-15.43). Studies also reported an increase in granulation and wound-healing rates in patients treated with NPWT therapy. No data on patient satisfaction or experience were reported. While all the studies included in the review indicated that the NPWT therapy is more effective than conventional dressings, the quality of the studies were weak and the nature of the inquiries in terms of outcome and patient selection divergent. There is a strong need for larger trials to assess NPWT therapy in diabetes care with different groups of patients and in relation to different clinical objectives and parameters.

Resource utilization and economic costs of care based on a randomized trial of vacuum-assisted closure therapy in the treatment of diabetic foot wounds

Background To evaluate resource utilization and direct economic costs of care for patients treated with negative-pressure wound therapy (NPWT), using the Vacuum-Assisted Closure (V.A.C.) system, compared to standard moist wound therapy (MWT). Methods A total of 162 diabetic patients with post-amputation wounds (up to the trans-metatarsal level) entered a 16-week, randomized clinical trial. Patients randomized to V.A.C. (n = 77) received therapy with dressing changes every 48 hours. Control patients (n = 85) received standard MWT. Resource utilization, procedures, and direct costs were calculated and analyzed in this post hoc retrospective study. Results There was no difference between groups for in-patient hospital stay (number of admissions or length of stay). More surgical procedures (including debridement) were required in the MWT group (120 vs 43 NPWT, P <.001). The average number of dressing changes performed per patient was 118.0 (range 12–226) for MWT versus 41 (6–140) for NPWT (P = .0001). The MWT group had 11 (range 0–106) outpatient treatment visits during the study versus 4 (range 0–47) in the NPWT group (P <.05). The average direct cost per patient treated for 8 weeks or longer (independent of clinical outcome) was $27,270 and $36,096 in the NPWT and MWT groups, respectively. The average total cost to achieve healing was $25,954 for patients treated with NPWT (n = 43) compared with $38,806 for the MWT group (n = 33). Conclusion Treatment of diabetic patients with post amputation wounds using NPWT resulted in lower resource utilization and a greater proportion of patients obtaining wound healing at a lower overall cost of care when compared to MWT.