Stump Ulcers and Continued Prosthetic Limb Use
Open Access
- 1 December 2006
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Prosthetics and Orthotics International
- Vol. 30 (3), 279-285
- https://doi.org/10.1080/03093640600836139
Abstract
Stump ulcers are common problems in amputees. Temporary discontinuation of prosthetic limb use is frequently employed to facilitate healing. Inevitably, this limits activity and may, for instance, prevent an amputee from going to work. A survey of clinical practice was carried out based on the premise that controlled continued prosthetic limb use in patients with stump ulcers will not adversely affect the ulcer nor prevent healing. The survey would also form a basis for developing future guidelines in the management of stump ulcers. All consecutive patients attending the Chapel Allerton Hospital prosthetic clinic between January 2003 and May 2004 with stump ulcers were recruited into the study. Primary outcome measures were changes in the surface area of the ulcers and in clinical photographs taken on 2 occasions 6 weeks apart. Some 102 patients with a mean age 60 years (range 18 – 88 years) were recruited. Eight patients who were established prosthetic limb users did not complete the study and were excluded from the analysis. Of the patients 52 were newly referred patients with delayed surgical wound healing while 42 were established prosthetic limb users for at least 1 year. Continued prosthetic limb was associated with a significant reduction in ulcer size (p < 0.05). Mean sizes of the ulcers at first and second observations were 3.30 cm2 (range 0.06 – 81) and 0.70 cm2 (range 0.00 – 13.00) respectively. The ulcers improved in 83 cases while two were unchanged. Deterioration was observed in nine cases. The current clinical practice is to allow most of the patients to commence or continue prosthetic limb wearing despite the presence of stump ulceration. This observational study found that, despite prosthetic use, 60 (64%) cases healed completely within the six-week study period and 23 (25%) ulcers reduced in size. The ulcers were unchanged in 2% of the cases. Deterioration was observed in nine (9%) cases. This survey suggests that the current practice of allowing patients to use their prostheses is safe. A clinical trial is now needed to establish whether this practice alters healing rate or has any other disadvantages for new or established amputees.Keywords
This publication has 8 references indexed in Scilit:
- Neuropathic Diabetic Foot UlcersNew England Journal of Medicine, 2004
- Employment status, job characteristics, and work-related health experience of people with a lower limb amputation in The NetherlandsArchives Of Physical Medicine and Rehabilitation, 2001
- Unna and elastic postoperative dressings: Comparison of their effects on function of adults with amputation and vascular diseaseArchives Of Physical Medicine and Rehabilitation, 2000
- Skin disorders in amputeesJournal of the American Academy of Dermatology, 2000
- Healing of open stump wounds after vascular below-knee amputation: Plaster cast socket with silicone sleeve versus elastic compressionArchives Of Physical Medicine and Rehabilitation, 1999
- Outcome of fitting an ICEROSS prosthesisProsthetics and Orthotics International, 1996
- The Effect of Semirigid Dressings on Below-Knee AmputationsPTJ: Physical Therapy & Rehabilitation Journal, 1994
- The management of healing problems in the dysvascular amputeeProsthetics and Orthotics International, 1982