Evaluation of Vacuum-Assisted Dressing on Treatment of Ischemic Above Knee Amputation Stump and the Rate of Healing of the Amputation Stump
Authors: Abdelmageed Shaban Mohamed Mohamed , Rizk Mohammed Abdel Monaem , Mahran Mostafa Mohammed Saad , Ramadan Hadeir Mostafa Mosaad 
Published: November 2024

Abstract

Background
AKA Amputation results in permanent disability and a significant alteration in the individual's life and performance. Vascular problems are the leading cause of Lower limb amputations (LLA s) in developed countries. Delayed wound healing particularly in difficult wounds and in elderly with co morbidities is a major concern.

Aim of the Work
The aim of the present study is to Asses healing time after using the vacuum assisted dressing therapy in wounds of ischemic above knee amputation (AKA) open stump. Also to Asses reintervention rates after using the vacuum-assisted dressing therapy as a dressing in ischemic AKA open stump wounds.

Patients and Methods
This is a prospective cohort study, conducted at Ain Shams University Hospitals and Nasser institute Hospital in Cairo on 55 patients with ischemic above knee amputation stump.

Results
All patients (55) had no femoral pulse and underwent AKA due to arterial disease, 33 patients underwent revasculrization with trial of angioplasty prior to amputation. 40 patients had occluded CIA, 15 of them didn’t obtain complete closure of the stump while the other 25(62.5 %) obtained complete closure, while 8(66.7%) of them needed reintervention with another session of amputation to go with a higher level of amputation(new stump length &lt; or = 15 cm) in order to obtain complete closure. Only 2 patients of them didn’t obtain complete closure after the higher amputation level. There was a statistically significant positive correlation between new stump length and baseline stump length with r and p-value of (0.774 and 0.003) and also statistically significant positive correlation between weeks for complete closure with baseline length and TLC with r and p-value of (0.491 and 0.001) and (0.682 and 0.000) respectively. Any patient with stump length less than 15 cm either primarly or after reintervention achieved complete closure of the stump Which makes us to come to a conclusion of that VAC/NPWT Can be used in ischemic AKA stump wounds cautiously with negative pressure less than 125 mmhg intermittently with a stump length equal or less than 15 cm after good debridment of the wound from any necrotic tissues and good monitoring of the patients lab and TLC while giving patients good antibiotics after culture from the wound, While ischemic AKA stumps with stump length more than 15 cm, VAC proved to be non effective and not aiding the healing process.

Conclusion
VAC/NPWT Can be used in ischemic AKA stump wounds cautiously with negative pressure less than 125 mmhg intermittently with a stump length equal or less than 15 cm after good debridment of the wound from any necrotic tissues and good monitoring of the patients lab and TLC while giving patients good antibiotics after culture from the wound, While ischemic AKA stumps with stump length more than 15 cm, VAC proved to be non effective and not aiding the healing process.