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A Multimodal Approach for Limb Preservation of Dehisced Amputations with Bone Exposure
Ioannis Tsouknidas1, Garrett Tibbets2, Athanasios Angistriotis2
1Department of Surgery, Lankenau Medical Center, Wynnewood, PA; Department of Surgery, Stony Brook Southampton Hospital, Southampton, NY; Department of Surgery, Stony Brook University Hospital, Stony Brook, NY.
A novel seven-step algorithm successfully treated dehisced lower extremity amputation stumps with bone exposure and osteomyelitis, achieving complete healing in all patients. This approach offers a limb-sparing alternative to further amputation.
Area of Science:
- Limb reconstruction surgery
- Wound healing research
- Amputation complication management
Background:
- Nontraumatic amputations are increasing, impacting ambulation success.
- Wound infections and stump dehiscence are common after lower extremity amputations.
- Osteomyelitis with bone exposure often necessitates more proximal amputation.
Purpose of the Study:
- To evaluate a novel seven-step treatment algorithm for dehisced amputation stumps with bone exposure.
- To assess the efficacy of aggressive revascularization and advanced wound care in limb salvage.
- To determine healing outcomes and recurrence rates in treated patients.
Main Methods:
- Retrospective chart review of 22 dehisced stumps with osteomyelitis (2018-2024).
- Treatment involved a seven-step algorithm including revascularization and advanced wound care (NPWT, collagen, matrix dressings).
- Data collected on patient demographics, treatment specifics, and follow-up outcomes.
Main Results:
- All 19 patients (22 stumps) achieved complete healing.
- Average healing time was 171.8 days, with a mean wound-free period of 323.9 days.
- Two stumps experienced recurrence; 14 revascularization procedures were performed.
Conclusions:
- The seven-step algorithm effectively closes dehisced stumps with bone exposure in selected patients.
- Aggressive revascularization and advanced wound care are key components of successful limb salvage.
- Close patient follow-up and adherence to treatment are crucial for optimal outcomes.
