Document Detail

Stump ulcers and continued prosthetic limb use.
MedLine Citation:
PMID:  17162518     Owner:  NLM     Status:  MEDLINE    
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.
A Salawu; C Middleton; A Gilbertson; K Kodavali; V Neumann
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  Prosthetics and orthotics international     Volume:  30     ISSN:  0309-3646     ISO Abbreviation:  Prosthet Orthot Int     Publication Date:  2006 Dec 
Date Detail:
Created Date:  2006-12-12     Completed Date:  2007-03-06     Revised Date:  2007-10-26    
Medline Journal Info:
Nlm Unique ID:  7707720     Medline TA:  Prosthet Orthot Int     Country:  England    
Other Details:
Languages:  eng     Pagination:  279-85     Citation Subset:  IM    
Department of Rehabilitation Medicine, Chapel Allerton Hospital, Leeds, UK.
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MeSH Terms
Aged, 80 and over
Amputation Stumps / pathology,  physiopathology*
Amputees / rehabilitation*
Artificial Limbs / adverse effects*
Middle Aged
Pressure Ulcer / etiology*,  physiopathology
Prosthesis Fitting
Stress, Mechanical
Time Factors
Treatment Outcome
Wound Healing / physiology*
Comment In:
Prosthet Orthot Int. 2007 Jun;31(2):207-8; author reply 209-10   [PMID:  17520496 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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