Utilizing Of Removable Rigid Dressing To Decrease Bka To Aka Conversion Rates
Robin Fencel, MS, Suzanna Fitzpatrick, DNP, Nora F. Dunlap, MS, Khanjan Nagarsheth, MD.
University of Maryland Medical Center, Baltimore, MD, USA.
OBJECTIVES: Below the knee amputations (BKA) are preferred to above the knee amputations (AKA) due to BKA leading to better functional outcomes for amputees. However, following BKA patients can have post operative complications including delayed wound healing, edema, contractures, and are at an increased risk for falls. Assessment of the literature for best practice identified that the utilization of a removable rigid dressing, such as an Ampushield, can improve post-operative BKA care by decreasing edema, expedite wound healing, promote earlier ambulation, and reduce the hospital length of stay when compared to a soft dressing. We hypothesized that there would be a decrease of conversions from BKA to AKA following utilizing of the Ampushield device.
METHODS: In a large urban academic medical center, it was noted that there was a need for better post operative BKA care due to the rate of conversions to AKA while using the standard soft splint or knee immobilizer. A retrospective chart review was performed of all BKA surgeries by the vascular surgery team pre and post implementation of utilizing the ridged removal dressing, Ampushield.
RESULTS: During the two-year time period starting fiscal year 2017, there were 67 patients who underwent BKA surgery. 19 out of the 67 (28%) required conversion to AKA within the first four week post operative period due to delayed wound healing or infection. Beginning fiscal year 2019, the vascular surgery team started utilizing a removable rigid dressing, Ampushield, in all post operative BKA patients based on literature citing this as best practice. During the next two-year period a total of 65 patients underwent BKA surgery, with only 7 (10%) requiring conversion to AKA within the four week post operative period.
CONCLUSIONS: Utilizing a ridged removal dressing, such as an Ampushield, after BKA can improve wound healing, protect the residual limb, and lead to less conversions to AKA. In this retrospective review at a single institution there is promising data showing a decrease in conversion of BKA to AKA following utilization of the Ampushield device. Patients who have undergone BKA surgery can have full mobility, functioning, and excellent quality of life after major lower extremity amputation if a BKA can be salvaged and the use of an Ampushield decreases the risk of conversion to AKA.
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