A Contemporary Comparative Analysis of Immediate Postoperative Prosthesis Placement Following Below-Knee Amputation
A Contemporary Comparative Analysis of Immediate Postoperative Prosthesis Placement Following Below-Knee Amputation
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DOI：
10.1016/j.avsg.2012.10.031
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发表时间：
2013-11-01
影响因子：
1.5
通讯作者：
Baril, Donald T.
中科院分区：
文献类型：
--
作者：
Ali, Mujtaba M.;Loretz, Lorraine;Baril, Donald T.
背景：尽管外周动脉疾病的治疗取得了进展，但仍有相当数量的患者最终需要截肢。传统上，膝下截肢的术后管理涉及软压缩敷料，以允许在初始假体装配之前完全愈合残端。这种技术与长时间的活动受限有关，使患者面临适应不良或跌倒的风险，并有损伤残端的风险。相比之下，术后即刻假体（IPOP）放置允许患者在术后第1天开始截肢和康复，这可能具有显著的生理和心理益处。本研究的目的是比较IPOP放置患者与传统软压缩敷料放置管理的历史对照组的结果。方法：所有连续接受IPOP的膝下截肢患者的医疗记录（IPOP组; 37例患者，2007-2010年）和所有接受传统软压缩敷料放置且为IPOP候选者的患者（非IPOP组; 35例患者，2006-2007年）进行了回顾性分析。比较了IPOP组和非IPOP组的患者合并症和术前Ampere状态。评价的主要结局包括围手术期全身并发症、伤口并发症、是否需要手术翻修以及放置最终假体的时间。数据进行了分析，使用卡方和学生的t-test.Results：术前合并症和患者的特点，两组是相似的，虽然IPOP组是年轻的（61.5与69.0岁，P=0.01）。两组间即刻围手术期全身并发症发生率无显著差异（IPOP 29.7% vs.非IPOP 31.4%; P=0.876）。术后伤口并发症发生率如下：伤口感染（IPOP 18.9% vs.非IPOP 25.0%; P=0.555）、伤口裂开（IPOP 29.7% vs.非IPOP 25.0%; P=0.673）和切口分离皮肤破裂（IPOP 18.9% vs.非IPOP 3.6%; P=0.062）。IPOP组患者术后福尔斯发生率更低（IPOP组10.8% vs非IPOP组21.4%; P=0.240）。非IPOP组的翻修需求显著更高（IPOP 5.4% vs.非IPOP 27.6%; P=0.013）。从手术到放置的预备假体的时间为51天，在IPOP group.Conclusions：接受IPOP的患者有类似的围手术期全身和伤口并发症的发生率相比，那些患者接受传统的膝下截肢，但不太可能需要手术翻修。IPOP的使用允许早期截肢和康复，这可能对心理有益，并可能减少长期制动的后遗症。对于所有需要膝下截肢的合适候选人，应考虑IPOP申请。
Background: Despite advances in the treatment of peripheral arterial disease, a significant number of patients ultimately require major amputations. Traditionally, postoperative management of a below-knee amputation involves soft compressive dressings to allow for complete stump healing before initial prosthesis fitting. This technique is associated with a prolonged period of limited mobility, placing patients at risk for deconditioning or fall with a risk of injury to the stump. In contrast, immediate postoperative prosthesis (IPOP) placement allows patients to begin ambulation and rehabilitation on postoperative day 1, which may be of significant physiologic and psychological benefit. The purpose of this study is to compare the outcomes of patients undergoing IPOP placement to those of a historical control group managed with traditional soft compressive dressing placement.Methods: Medical records of all consecutive below-knee amputation patients who underwent IPOP (IPOP group; 37 patients, 2007-2010) and all patients who underwent traditional soft compressive dressing placement and were IPOP candidates (non-IPOP group; 35 patients, 2006-2007) were retrospectively reviewed. Patient comorbidities and preoperative ambulation status were compared between the IPOP and the non-IPOP groups. Primary outcomes evaluated included perioperative systemic complications, wound complications, need for surgical revision, and the time until placement of a definitive prosthesis. Data were analyzed using the chi-squared and Student's t-test.Results: Preoperative comorbidities and patient characteristics of the 2 groups were similar, although the IPOP group was younger (61.5 vs. 69.0 years; P=0.01). Immediate perioperative systemic complication rates were not significantly different between the 2 groups (IPOP 29.7% vs. non-IPOP 31.4%; P=0.876). Postoperative wound complication rates were as follows: wound infection (IPOP 18.9% vs. non-IPOP 25.0%; P=0.555), wound dehiscence (IPOP 29.7% vs. non-IPOP 25.0%; P=0.673), and skin breakdown separate from the incision (IPOP 18.9% vs. non-IPOP 3.6%; P=0.062). Patients in the IPOP group trended towards fewer postoperative falls (IPOP 10.8% vs. non-IPOP 21.4%; P=0.240). The need for revision was significantly greater in the non-IPOP group (IPOP 5.4% vs. non-IPOP 27.6%; P=0.013). The time from surgery to placement of the preparatory prosthesis was 51 days in the IPOP group.Conclusions: Patients undergoing IPOP have similar perioperative systemic and wound complication rates compared to those patients undergoing conventional below-knee amputation, but are less likely to require surgical revision. The use of IPOP allows for early ambulation and rehabilitation, which may be of psychological benefit and may decrease the sequelae of prolonged immobilization. IPOP application should be considered for all appropriate candidates requiring below-knee amputation.