A Multimodal Approach for Limb Preservation of Dehisced Amputations with Bone Exposure.

IF 1.6 4区医学 Q3 PERIPHERAL VASCULAR DISEASE

Annals of vascular surgery Pub Date : 2025-09-18 DOI:10.1016/j.avsg.2025.09.019

Ioannis Tsouknidas, Garrett Tibbets, Athanasios Angistriotis, George Koullias

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引用次数: 0

Abstract

Purpose: The prevalence of non-traumatic amputations continues to rise annually. The length of the preserved limb is directly associated with the success of ambulation. Wound infections after lower extremity amputations are very common, and reoperation is necessary in up to 61%. When dehisced stumps are complicated by bone exposure and osteomyelitis, more proximal amputation is traditionally performed.

Methods: A retrospective chart review of the electronic medical records from 2016 to 2024 was conducted at our institution, and dehisced amputated stumps with and bone exposure were included for final analysis. All cases were treated with a novel seven-step treatment algorithm, incorporating aggressive revascularization, standard and advanced wound care modalities. Data collection included patient characteristics, treatment details and follow-up outcomes.

Results: A total of 22 dehisced stumps with osteomyelitis, from 19 patients (73.7% male, 26.3% female), with an average wound size of 27.4 cm² were included. Fourteen revascularization procedures were performed. Negative pressure wound therapy, collagen products, and amniotic or acellular matrix dressings were used in 54.5%, 68.2% and 72.7% of the stumps, respectively. Complete healing was achieved in all patients with an average healing time of 171.8 days. Wound recurrence occurred in two stumps. The mean wound-free period was 323.9 days.

Conclusions: The proposed treatment algorithm enables successful closure of dehisced stumps with bone exposure in selected patients. Adherence to the treatment and close follow-up are essential for optimal outcomes.

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骨外露性骨折断肢的多模态保肢方法。

目的：非创伤性截肢的患病率逐年上升。保留肢体的长度与行走的成功与否直接相关。下肢截肢后伤口感染非常常见，61%的患者需要再次手术。当残肢破裂并发骨暴露和骨髓炎时，传统上更倾向于近端截肢。方法：对我院2016年至2024年电子病历进行回顾性图表分析，纳入断肢伴骨外露病例进行最终分析。所有病例均采用新颖的七步治疗算法，结合积极的血运重建术，标准和先进的伤口护理模式。数据收集包括患者特征、治疗细节和随访结果。结果：19例骨髓炎患者共22例骨裂残端，其中男性73.7%，女性26.3%，平均创面大小27.4 cm2。进行了14次血运重建术。负压创面、胶原蛋白制品、羊膜或脱细胞基质敷料分别占残肢的54.5%、68.2%和72.7%。所有患者均完全愈合，平均愈合时间为171.8天。2个残肢伤口复发。平均无创面时间为323.9 d。结论：所提出的治疗算法能够在选定的患者中成功关闭骨暴露的裂开残端。坚持治疗和密切随访对获得最佳结果至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of vascular surgery 医学-外科

CiteScore

3.00

自引率

13.30%

发文量

603

审稿时长

50 days

期刊介绍： Annals of Vascular Surgery, published eight times a year, invites original manuscripts reporting clinical and experimental work in vascular surgery for peer review. Articles may be submitted for the following sections of the journal: Clinical Research (reports of clinical series, new drug or medical device trials) Basic Science Research (new investigations, experimental work) Case Reports (reports on a limited series of patients) General Reviews (scholarly review of the existing literature on a relevant topic) Developments in Endovascular and Endoscopic Surgery Selected Techniques (technical maneuvers) Historical Notes (interesting vignettes from the early days of vascular surgery) Editorials/Correspondence