Lower Limb Amputation: A Modern Approach to Surgical Dressings

Lower Limb Amputation:
A Modern Approach to Surgical Dressings.

Despite advances in vascular and endovascular techniques, rates of lower limb amputation have remained static over the last decade in the United Kingdom. (The Amputee Statistical Database 2005/06). Amputation of the lower limb also has the highest rates of surgical site infection in the U.K. (Surgical Site Infection Surveillance Service 2006). This leads to wound breakdown, increasing length of stay and often further surgery. This negatively impacts on health care resources and patients’ quality of life (NICE 2008).

Following a cluster of amputation wound dehiscence and infection, a review of the surgical dressings was undertaken. Traditionally such wounds were managed with a simple surgical dressing. However, with the high risk of tissue breakdown and infection a more modern approach has been suggested. (Harker 2006). A combination of a hydrofibre dressing covered with a thin hydrocolloid dressing has been shown to effectively reduced the risk of post operative wound complications in patients’ undergoing total hip and knee arthroplasty (Clarke, Deakin et al 2009).

In the authors unit, this modern system of surgical dressing has been implemented for all patients’ undergoing lower limb amputation. Within 12 months there was a 10% reduction in wound complications (National Vascular Database, local data). Indications from this year’s audit data show a further reduction. The system has a longer wear time, good conformity and flexibility than the previous dressings. The opacity of the thin hydrocolloid  also allows inspection of the peri-wound tissue. Improvements in both ease of use and patient comfort were also noted. Given the cost of a surgical site infection and the added risk of litigation, such a change of practice has the potential to reduce health service expenditure.