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Lower extremity amputation: open versus closed.

J Senkowsky1, M K Money, M D Kerstein

  • 1Tulane University School of Medicine, New Orleans, Louisiana.

Angiology
|March 1, 1990
PubMed
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Open wound techniques in lower extremity amputations significantly improve healing rates compared to primary skin closure, reducing complications and hospital stays. This is crucial for managing nonhealing lesions and peripheral vascular disease.

Area of Science:

  • Vascular Surgery
  • Wound Healing
  • Amputation Techniques

Background:

  • Nonhealing lesions and peripheral vascular disease are common indications for lower extremity amputations.
  • Wound breakdown and healing complications significantly impact patient outcomes and healthcare costs.

Purpose of the Study:

  • To compare the healing rates and postoperative outcomes of open versus primary skin closure techniques in lower extremity amputations.
  • To identify optimal wound management strategies for amputations to minimize revision rates and hospital stays.

Main Methods:

  • Retrospective analysis of 117 lower extremity amputations.
  • Categorization of amputations by level: toe, transmetatarsal (TMA), below-the-knee (BKA), and above-the-knee (AKA).
  • Comparison of wound healing rates, revision rates, and mean postoperative hospital days between open and closed wound techniques.

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Main Results:

  • Open amputation techniques demonstrated significantly higher healing rates (100% healed without revision in 54 cases) compared to primary skin closure (10/63 nonhealing).
  • Toe amputations: open technique (14 patients) averaged 9 postoperative days; closed (8 patients) averaged 5.8 days, but revisions significantly increased stay (36.3 days).
  • Overall amputation healing rates were significantly better with open wounds, though TMA, BKA, and AKA showed no significant difference between open and closed, except when revisions were needed.

Conclusions:

  • Open wound management in lower extremity amputations, particularly for nonhealing lesions, leads to superior healing rates and fewer revisions.
  • While closed techniques may offer shorter initial hospital stays, open techniques are associated with better long-term healing outcomes, especially in complex cases.
  • The choice of amputation closure technique should be individualized based on wound characteristics and patient factors to optimize healing and minimize complications.