Robin Fencel, University of Maryland Medical Center, 22 S Greene Street, Baltimore, MD 21224, USA. Email:
Am Surg. 2023 Jun;89(6):2476-2480. doi: 10.1177/00031348221101482. Epub 2022 May 13.
INTRODUCTION/OBJECTIVE: Below the knee amputations (BKAs) are preferred to above the knee amputations (AKAs) due to better rehabilitation and functional outcomes. Assessment of literature for best practice identified that utilization of a removable rigid dressing (RRD) improves post-operative BKA care by expediting wound healing and reduces the hospital length of stay compared to a soft dressing. We hypothesized that there would be a decrease of conversions from BKA to AKA following utilizing of RRD device.
Retrospective chart review of all BKA performed by the vascular surgery service at a tertiary care hospital between January 2017 and December 2021. Demographic data obtained including age, body mass index (BMI), comorbid conditions, infection at time of BKA, anesthesia type, and operative blood loss. Data analyzed using Wilcoxon rank sum, Fisher's exact, and Student's t-tests. This study was approved by the institutional review board.
From 2017 to 2019, conversion to AKA occurred in 18 out of the 42 patients who underwent BKA (42.86%) within the first 4-week post-operative period. After the standard used of a RRD, 53 patients underwent BKA surgery, with only 4 (7.55%) requiring conversion to AKA within the 4-week post-operative period.
Utilizing a RRD after BKA can improve wound healing, protect the residual limb, and help prevent conversions to AKA. In this retrospective review at a single institution there was a decrease of conversion from BKA to AKA in a 2-year period. Ridged removal dressings should be considered first-line therapy in the post-operative care of BKA patients.
引言/目的：由于更好的康复和功能结果，膝下截肢（BKAs）优于膝上截肢（AKAs）。对文献进行最佳实践评估发现，使用可移动刚性敷料（RRD）可通过加速伤口愈合并减少与软敷料相比的住院时间来改善 BKA 术后护理。我们假设，在使用 RRD 装置后，BKA 向 AKA 的转换会减少。
对 2017 年 1 月至 2021 年 12 月在一家三级护理医院血管外科服务部门进行的所有 BKA 进行回顾性图表审查。获得的人口统计学数据包括年龄、体重指数（BMI）、合并症、BKA 时的感染、麻醉类型和手术失血量。使用 Wilcoxon 秩和检验、Fisher 确切检验和 Student t 检验进行数据分析。这项研究得到了机构审查委员会的批准。
2017 年至 2019 年，在 42 名接受 BKA 的患者中，有 18 名（42.86%）在术后 4 周内发生 AKA 转换。在标准使用 RRD 后，53 名患者接受了 BKA 手术，只有 4 名（7.55%）在术后 4 周内需要转换为 AKA。
BKA 后使用 RRD 可改善伤口愈合、保护残肢并有助于防止 AKA 转换。在单机构的回顾性研究中，在 2 年内 BKA 向 AKA 的转换减少。在 BKA 患者的术后护理中，刚性去除敷料应被视为一线治疗。
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