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World Wide Wounds have just published the full text of this article: Wound healing complications associated with lower limb amputation
Abstract: The majority of patients undergoing amputation of the lower limb have peripheral vascular disease, often resulting in significant morbidity and mortality. The incidence of amputations is higher in smokers, rises with age and is higher in men than women. Furthermore, people with diabetes form just less than half of all amputees. Consequently, it is not surprising to find that such patient risk factors can result in an array of wound-healing difficulties, thus prolonging debilitation and reducing quality of life. The UK's increasingly ageing population means that more elderly patients will be operated on in the future, thus giving rise to a growing trend in postoperative tissue viability problems where skin fragility and multiple pathologies such as diabetes and peripheral vascular disease co-exist. Hence wound healing complications associated with amputation are becoming more commonplace, requiring sophisticated management strategies to meet the needs of these vulnerable patients. The most important factor in ensuring a successful amputation is the correct choice of amputation site based on assessment of limb perfusion and functional requirements. The following factors will affect the outcome of amputation: the patient's nutritional status, age, tissue perfusion, smoking habits, infection and the presence of co-existing diseases such as anaemia and renal failure. This paper describes a number of problems associated with amputation wound healing, including infection, tissue necrosis, pain, difficulties associated with the surrounding skin, bone erosion, haematoma, oedema and dehiscence/wound breakdown. It draws on the available literature to guide best practice in this complex area of surgical wound care and highlights the importance of multidisciplinary team working.
1. Lower limb amputations account for the majority of all amputations in the UK, with peripheral vascular disease and diabetes being the major reasons for surgery.
2. Within the population of patients with peripheral vascular disease, major lower extremity amputation results in significant perioperative morbidity and mortality.
3. Potential wound-healing complications associated with lower limb amputation stumps include infection, tissue necrosis, pain, problems associated with the surrounding skin, bone erosion, haematoma, stump oedema and dehiscence.
4. The highest rate of surgical site infection is associated with lower limb amputations.
5. Wound healing outcomes for amputees can be maximised by multidisciplinary team working.