Effects of Early Mobilization on Unhealed Dysvascular Transtibial Amputation Stumps: A Clinical Trial

VanRoss ER, Johnson S, Abbott CA. Effects of early mobilization on unhealed dysvascular transtibial amputation stumps: a clinical trial. Objective: To observe the effects of early mobilization on unhealed transtibial (TT) amputation stump wounds of dysvascular etiology. An "unhealed" stump was defined as having a wound greater than 1cm × 1cm at least 3 weeks after surgery. Design: An observational cohort study. Setting: This center receives about 250 new lower-limb amputees a year from over 50 surgeons working in 16 hospitals. Over 35% are unhealed. Participants: Sixty-six consecutive new TT amputees (age 62.8±10.8y) of dysvascular etiology (diabetes 50%) with unhealed stumps were recruited. Sixty-one percent were current or past smokers. The mean ± SD stump wound size was 7.7±2.7cm × 3.2±2.0cm. Interventions: The wound size was measured, and stump transcutaneous oxygen (TcpO2) and transcutaneous carbon dioxide (TcpCO2) were measured. Wounds were debrided and dressed by using a standard protocol. Mobilization using a Pneumatic Post-Amputation Mobility (PPAM) Aid for approximately 3 weeks was followed by provision of a TT prosthesis. A standard physiotherapy walking training program was performed. Main Outcome Measures: Stump wound healing, time to achieve healing, and resting transcutaneous oxygen pressure pre- and posttherapy. Results: Of the 66 amputees, 4 did not start. Sixty-two started; 6 withdrew, and 56 completed the trial. Complete wound healing was achieved in 74% (46/62) over a mean of 141 (87-270) days. The mean ± SD stump TcpO2 at baseline was 41.3±19.8mmHg and increased significantly to 50.6±21.9mmHg (P