Objectives: Optimal oedema control in the residuum is essential after lower limb amputation to help prevent complications such as delayed wound healing and delayed hospital discharge, which may result in increased costs and waiting lists. The aim of this study was to establish the current management of post-operative oedema in lower limb amputation in major amputation hospitals in the Republic of Ireland.
Method: A questionnaire was developed using the BACPAR Oedema guidance document and the relevant UK study on this area. The questionnaire included sections addressing the use of compression/shrinker socks, rigid dressings, wheelchair stump boards, PPAM-aid™, and elastic bandage wrapping. The questionnaire were posted to Vascular Consultants, Physiotherapists, Occupational Therapists and Clinical Nurse Managers, who manage acute lower limb amputation in the 9 major amputation hospitals.
Results: Thirty-six questionnaires were returned from 55 sent (65.5% response rate). Almost half (44%) measured residuum volume, with Physiotherapists most likely to do so. Nearly two-thirds (61%) weren't familiar with the BACPAR guidance document. The wheelchair stump board was the most common method used in almost 92% of respondents, mainly applied less than 1 week post-operatively, by Occupational Therapists. The compression sock was also used in 78% of surveys, mainly applied more than 10 days post-operatively, by Physiotherapists. The compression sock was most commonly donned during the day and removed at night. Rigid dressings were not used by almost 92% of respondents, the main reason reported for this was lack of knowledge. A positive finding was that Elastic Bandage Wrapping was not used in almost 80% of respondents, as it has been shown not to benefit patients in numerous studies. However, the main reason for non-use was lack of training or experience, as opposed to findings from previous research. The PPAM-aid™ was used in 78% of Physiotherapists, usually from 11 days post-operatively for 30 minute sessions.
Conclusions: This study has found evidence of sub-optimal oedema control after lower limb amputation and decreased awareness of relevant guidelines or research. The use of rigid dressings was very low among all professions, despite this area having the greatest evidence base. Compression sock and PPAM-aid™ use were also below recommended levels. There is a need for education and training on the application of rigid dressings, and the detrimental effect of elastic bandage wrapping if applied incorrectly. More research is required on the shrinker sock, wheelchair stump board and PPAM-aid™ to prove their effectiveness in oedema management after lower limb amputation.
References:
Bouch E, Burns K, Geer E, Fuller M, Rose A. (2012) Guidance for the multi-disciplinary team on the management of post-operative residuum oedema in lower limb amputees. British Association of Chartered Physiotherapists in Amputee Rehabilitation
Torrance L. (2014) The Management of Post-Operative Residuum Oedema: A Review of Current Practice. Unpublished Conference Presentation.
Ethical Approval: Ethical approval was obtained from the National Rehabilitation Hospital Research Ethics Committee.
