BACKGROUND AND PURPOSE: Following transtibial amputation, a rigid dressing of plaster of Paris has been reported to have advantages over a soft dressing regarding wound healing and reduction of edema, but use of the former may be limited by difficulties in application and in gaining access to the wound. An easily applicable and removable vacuum-formed rigid dressing (ORD) has recently been introduced. We compared the ORD with a conventional rigid plaster of Paris dressing with regard to wound healing, time to fitting of a prosthesis, and function with the prosthesis. METHOD:Patients undergoing transtibial amputation for peripheral vascular disease were randomized at surgery to receive ORD (O) or conventional rigid dressing (C) for 5 to 7 days, followed by compression therapy using silicone liner. The primary outcome measure was time to prosthetic fitting and secondary outcome measures included function with the prosthesis 3 months after amputation, measured with the Locomotor Capability Index (LCI) and the Timed "Up and Go" (TUG) test. All patients received prostheses with a total surface-bearing socket. RESULTS: Of 27 patients randomized to one or other dressing (15 O and 12 C), prosthetic fitting was achieved in 23 patients (mean age 76 (43-91) years; 13 (9 men) in the O group and 10 (5 men) in the C group). Wound healing was similar in both groups. Mean time to prosthetic fitting was 37 (26-54) days in the O group and 34 (21-47) days in the C group (adjusted mean difference 3, 95% CI: -3-9). At 3 months, mean LCI was 28 (6-42) in the O group and 25 (2-41) in the C group (mean difference -0.1, 95% CI: -8.5-8.2). Mean TUG was 41 (10-92) seconds and 29 (10-47) seconds, respectively (mean difference 14, 95% CI:-2-30). INTERPRETATION: The vacuum-formed rigid dressing appears to give results similar to those of the conventional rigid dressing regarding time to prosthetic fitting and patient's function with prosthesis.
RCT Entities:
BACKGROUND AND PURPOSE: Following transtibial amputation, a rigid dressing of plaster of Paris has been reported to have advantages over a soft dressing regarding wound healing and reduction of edema, but use of the former may be limited by difficulties in application and in gaining access to the wound. An easily applicable and removable vacuum-formed rigid dressing (ORD) has recently been introduced. We compared the ORD with a conventional rigid plaster of Paris dressing with regard to wound healing, time to fitting of a prosthesis, and function with the prosthesis. METHOD:Patients undergoing transtibial amputation for peripheral vascular disease were randomized at surgery to receive ORD (O) or conventional rigid dressing (C) for 5 to 7 days, followed by compression therapy using silicone liner. The primary outcome measure was time to prosthetic fitting and secondary outcome measures included function with the prosthesis 3 months after amputation, measured with the Locomotor Capability Index (LCI) and the Timed "Up and Go" (TUG) test. All patients received prostheses with a total surface-bearing socket. RESULTS: Of 27 patients randomized to one or other dressing (15 O and 12 C), prosthetic fitting was achieved in 23 patients (mean age 76 (43-91) years; 13 (9 men) in the O group and 10 (5 men) in the C group). Wound healing was similar in both groups. Mean time to prosthetic fitting was 37 (26-54) days in the O group and 34 (21-47) days in the C group (adjusted mean difference 3, 95% CI: -3-9). At 3 months, mean LCI was 28 (6-42) in the O group and 25 (2-41) in the C group (mean difference -0.1, 95% CI: -8.5-8.2). Mean TUG was 41 (10-92) seconds and 29 (10-47) seconds, respectively (mean difference 14, 95% CI:-2-30). INTERPRETATION: The vacuum-formed rigid dressing appears to give results similar to those of the conventional rigid dressing regarding time to prosthetic fitting and patient's function with prosthesis.
Authors: Jo C Dumville; Trish A Gray; Catherine J Walter; Catherine A Sharp; Tamara Page; Rhiannon Macefield; Natalie Blencowe; Thomas Kg Milne; Barnaby C Reeves; Jane Blazeby Journal: Cochrane Database Syst Rev Date: 2016-12-20
Authors: Gill Norman; Chunhu Shi; En Lin Goh; Elizabeth Ma Murphy; Adam Reid; Laura Chiverton; Monica Stankiewicz; Jo C Dumville Journal: Cochrane Database Syst Rev Date: 2022-04-26
Authors: Joan Webster; Zhenmi Liu; Gill Norman; Jo C Dumville; Laura Chiverton; Paul Scuffham; Monica Stankiewicz; Wendy P Chaboyer Journal: Cochrane Database Syst Rev Date: 2019-03-26
Authors: Gill Norman; En Lin Goh; Jo C Dumville; Chunhu Shi; Zhenmi Liu; Laura Chiverton; Monica Stankiewicz; Adam Reid Journal: Cochrane Database Syst Rev Date: 2020-05-01
Authors: Gill Norman; En Lin Goh; Jo C Dumville; Chunhu Shi; Zhenmi Liu; Laura Chiverton; Monica Stankiewicz; Adam Reid Journal: Cochrane Database Syst Rev Date: 2020-06-15