Postoperative Casting of Below-Knee Amputation Reduces StumpComplications

Area of Science:

• Orthopedic Surgery
• Amputee Medicine
• Wound Healing Research

Background:

• Below-knee amputation (BKA) has a high stump complication rate despite advances in limb salvage.
• Postoperative casting (PC) is a potential method to mitigate these complications.
• Comparing PC to elastic bandage with knee immobilizer (EBKI) is crucial for optimizing BKA outcomes.

Purpose of the Study:

• To compare the efficacy of PC versus EBKI in reducing below-knee amputation stump complications.
• To evaluate the impact of PC on wound healing, length of stay, and patient mobility.
• To identify the optimal postoperative stump dressing for BKA patients.

Main Methods:

• Retrospective cohort study of 116 patients (122 limbs) undergoing BKA between 2000-2023.
• Patients stratified into EBKI and PC groups based on postoperative stump dressing.
• Primary outcomes: wound healing at 6 weeks, length of stay (LOS). Secondary outcomes: stump complications and mobility scores.

Main Results:

• The PC group showed significantly higher wound healing rates at 6 weeks (P=0.007).
• PC group experienced lower rates of wound dehiscence (P=0.01) and shorter LOS (P=0.006).
• PC group achieved better mobility scores and fewer knee contractures compared to EBKI.

Conclusions:

• Postoperative casting (PC) effectively reduces BKA stump complications and shortens length of stay.
• PC improves postrehabilitation mobility and reduces knee contracture incidence.
• PC did not significantly impact postoperative infections, stump necrosis, or higher-level amputations.