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

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.