A comparison of immediate postoperative rigid and soft dressings for below-knee amputations

A variety of postsurgical dressings are used after a below-knee amputation (BKA), but there is no evidence-based guideline on which dressing to use. The purpose of this study was to compare the application of immediate postoperative rigid dressings or soft dressings on the healing times of BKA.

In this retrospective analysis we compared 151 patients who underwent BKA from 2000 to 2012 at Yale New Haven Hospital. Patient demographics were collected and the type of postoperative dressing utilized was recorded. Ninety-one patients received a rigid plaster or plastic dressing and 60 received a soft gauze dressing with knee immobilizer. Time was measured between amputation and initial casting of prosthesis.

Average age for the rigid dressing group was 58.6 years, with 78.2% presenting with diabetes mellitus, compared with the soft dressing group of 61.0 years, with 82.8%, respectively. Using a Kaplan-Meier analysis, patients fit with a rigid dressing demonstrated significantly decreased healing time from BKA to initial casting for a prosthesis (P = 0.02). After the first 60 days, 58.24% of patients who received a rigid dressing were ready to be cast, compared with 38.33% of patients receiving a soft dressing (P = 0.03).

Below-knee amputees had a significantly quicker healing time, as measured by the time to be cast for prosthesis, when a rigid dressing was used compared with a soft dressing. Consideration should be given to the use of a rigid dressing after BKA to expedite healing and promote earlier ambulation.