Article

Forty years of clinical experience and peer-reviewed research studies support the
use of nonweight-bearing removable rigid dressings (RRDs) as an effective means
of postoperative management of transtibial amputations.
We reviewed the published
medical evidence regarding the use of RRDs as a postoperative management
strategy, culminating in an evidence-based practice recommendation. Published
peer-reviewed literature on the topic was searched and classified by level of
evidence based on the research design using the scale recommended by the PM&R
(level I through V). The search uncovered a total of 15 articles, including 5
level I randomized controlled trials, 6 level III retrospective matched
controlled trials, and 4 level V case reports. A number of benefits associated
with the application of RRDs compared with soft dressings were reported across
these 15 studies. These included faster healing times, reduced limb edema,
preparatory contouring of the residual limb in anticipation of prosthetic use,
the prevention of knee flexion contractures, and reduced external trauma to the
limb. Also described were an increased probability of successful prosthetic use
and pain reduction. The RRDs studied permitted regular inspection of surgical
wounds with greater ease and consistency of application than traditional soft
dressing approaches. Rigid dressings provide all the same benefits of RRDs except
ease of wound inspection, therefore rendering them impractical for the 82% of
patients receiving an amputation for ischemic disease that are at high risk of
developing wound dehiscence. Weight-bearing immediate postoperative prostheses
are almost exclusively reserved for use on trauma patients who usually do not
show evidence of vascular or neurologic impairment. The inherent risks of falls
and inconsistent pressure on the surgical wound have further restricted their use
in practice to a limited patient type. The benefits of RRDs compared with soft
dressings are universally recognized in the published peer-reviewed medical
evidence to be superior to soft dressings. Based on the best-available current
published evidence, nonweight-bearing removable rigid dressings should be
considered the first treatment choice for the postoperative care of transtibial
amputees to optimize outcomes with regard to reductions in injury due to falls,
knee flexion contractures, edema, healing time, time to prosthetic fitting, and
pain. LEVEL OF EVIDENCE: II.
CI - Copyright (c) 2018 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS