Rigid dressings versus soft dressings for transtibial amputations

Abstract

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the benefits and harms of rigid dressings versus soft dressings for treating transtibial amputations. B A C K G R O U N D Description of the condition Lower limb amputation can result from non-traumatic causes (e.g. dysvascular disease, malignancy and congenital deficiencies) or traumatic causes (e.g. war injuries and work accidents) (Varma 2014; Ziegler-Graham 2008). Amongst these causes, dysvascular disease is most common and includes diseases such as diabetes and peripheral vascular disease (Varma 2014; Ziegler-Graham 2008). The incidence of lower limb amputation is estimated to be 24 per 100,000 in the USA (Moxey 2011), and 26 per 100,000 in the UK (Ahmad 2014). These estimates increase in people with diabetes, and estimates range from 410 to 3100 per 100,000 in the USA and from 147 to 248 per 100,000 in the UK (Moxey 2011). Trauma is the second most common cause of limb loss (Varma 2014; Ziegler-Graham 2008), and accounts for 16% of amputations in the USA (Tintle 2010), and 7% to 9% of amputations 1 Rigid dressings versus soft dressings for transtibial amputations (Protocol)

Removable Rigid Dressings for the Post-Operative Management of Leg Amputations

“…People may require a lower limb amputation (LLA) for a variety of causes, including non-traumatic conditions, such as diabetes peripheral vascular disease, and congenital deficiencies, or traumatic cases, such as injuries. 1 LLAs may be minor, defined as at the ankle, foot, or toe; or major, which includes through-knee, below-knee (transtibial) and above-knee (transfemoral) amputation. 2 Estimates of LLA vary by type, as well as by country, time frame, and other factors.…”

“…6 Soft dressings are relatively low-cost, easy to apply, and allow for the wound to be checked if needed. 1,6 However, they are associated with greater risk of injury from external trauma and increased risk of knee flexion contractures. 6 They also have a tendency to fall off more easily, and could place uneven pressures on the residual limb, if not applied correctly, which may inhibit healing.…”

“…6 An RRD is a type of rigid dressing that can also be easily removed to provide access to the wound site if needed without requiring a new cast be made after the inspection; however, they may also have a higher risk of knee flexion contractures compared to non-removable rigid dressings. 1,6 The choice of dressing used seems to vary between sites, based on factors such as training and local practice patterns. 6 The objective of this report is to identify and summarize current evidence regarding the clinical effectiveness, cost-effectiveness, and recommendations from evidence-based guidelines of RRDs versus alternative dressings for the post-operative management of people who underwent leg amputation.…”

“…Two SRs with meta-analyses 1,12 1 RCT, 13 and 3 evidence-based guidelines [14][15][16] were included in this report. Both SRs 1,12 had broader inclusion criteria for the intervention than this review, comparing rigid dressings (including RRDs). However, both focused on transtibial amputations and had narrower comparator criteria limited to soft dressings.…”

“…However, both focused on transtibial amputations and had narrower comparator criteria limited to soft dressings. 1,12 Where metaanalyses included studies not relevant to this report, only data from the individual studies were reported. Only the primary clinical studies that met the inclusion criteria are presented in this report.…”