Ulcerated Below-the-Knee Stump

Abstract

Ulcerative lesions appearing on a below-the-knee (BK) stump often delay permanent prosthesis fitting and rehabilitation or prevent the user of a perma nent prosthesis from resuming the ambulatory state. Seventeen patients (11 men, 6 women), with an average age of 61.4 (range 52 to 71) years, had under gone BK amputation for vascular disease (rest pain or gangrene, or both, with ankle:brachial index ratios < 0.15); 5 patients (3 men, 2 women) had diabetes controlled with insulin. All patients had a history of smoking with associated cardiovascular disease determined by physical examination or electrocardio gram, or both. Fourteen patients did not have initial healing after their BK amputation; the other 3 had a BK amputation in the distant past (twelve, eight een, and twenty months previously) and a nonhealing ulcer. All patients were referred for revision to an above-the-knee (AK) amputation; none came to AK amputation. All patients were treated with intravenous cephalosporins, de bridement, whirlpool, fine mesh gauze dressings, and a softstem air splint. The air splint prosthesis allowed proprioception, balance, gait, and total contact compression at 25 mm Hg when ambulatory. All wounds healed in fourteen to twenty-four days, allowing return to the permanent prosthesis in 3 patients and early measurement and fitting (no delay) of the remaining 14 patients for a permanent prosthesis. The softstem air splint temporary prosthesis represents an adjunctive measure in management of a nonhealing lesion on the stump of a BK amputee. It can facilitate rehabilitation via maintenance of gait, pro prioception, balance, and shape.