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Wound Healing Complications Associated with Lower Limb Amputation. Literature Review. Lower Limb Amputation (LLA). LLA’s account for the majority of all amputations in Australia, the UK and the US Peripheral vascular disease and diabetes are a major cause of lower limb amputation

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lower limb amputation lla
Lower Limb Amputation (LLA)
  • LLA’s account for the majority of all amputations in Australia, the UK and the US
  • Peripheral vascular disease and diabetes are a major cause of lower limb amputation
  • Approximately 85-90% of lower limb amputations in the developed world are caused by peripheral vascular disease

Murphy (2006)

morbidity mortality
Morbidity & Mortality
  • Major lower extremity amputations are still associated with considerable morbidity and mortality – Ploeg et al (2005), Leung et al (2004)
  • De Godoy et al (2005) – high mortality rate
  • Peng & Tan (2000) – 19% infection

8% revision

morbidity mortality1
Morbidity & Mortality
  • Potential wound-healing complications include infections, tissue necrosis, pain, problems associated with the surrounding skin, bone erosion, haematoma, residual limb oedema and dehiscence
infection
Infection
  • Can pose serious complications for the amputee (Murphy 2006)
  • Murphy et al (2001) – MRSA linked to high mortality, surgical revision and debridement
  • Richards et al (2005) – MRSA infection has a poor prognosis, prophylaxis may be effective
treatment
Treatment
  • Armstrong & Lavery (2005)

RCT of 162 patients

NPWT versus standard moist wound care

More patients healed with NPWT and faster

  • Greenberg et al

Single case study – 6 month old girl

Tissue-engineer skin applied to chronic wound in non-healing amputation stump

treatment1
Treatment
  • Dalla et al (2003)

Use of follow-up program decreased re-ulceration & re-amputation in diabetic post-op patients

  • Vigier et al (1999)

RCT of two groups of 28 subjects

Plaster cast socket with silicone sleeve versus elastic compression bandages

Plaster socket led to increased healing and decreased hospital stay