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Treatment of stump complications after above-knee amputation using negative-pressure wound therapy.

Introduction
The stump wound complications after above-knee amputation lead to other problems,
such as prolonged rehabilitation, delayed prosthetic restoration, the increase in total treatment cost
and high mortality rates.


Objective
To evaluate the safety and outcomes of negative-pressure wound therapy (NPWT) using
Vacuum-Assisted Closure (VAC®) therapy in patients with stump complication after above-knee amputation
(AKA).


Methods
From January 2011 to July 2014, AKA was performed in 137 patients at the University Cardiovascular
Clinic. Nineteen (12.4%) of these patients (mean age 69.3 ± 9.2 years) were treated with NPWT.
The following variables were recorded: wound healing and hospitalization time, rate of NPWT treatment
failure, and mortality.


Results
AKA was performed in 17 (89.5%) patients after the vascular or endovascular procedures had
been exhausted, while urgent AKA was performed in two (10.5%) patients due to uncontrolled infection.
The time before NPWT application was 3.1 ± 1.9 days and the duration of the NPWT use ranged from 15
to 54 days (mean 27.95 ± 12.1 days). During NPWT treatment, operative debridement was performed in
12 patients. All the patients were kept on culture-directed intravenous antibiotics. The average hospital
length of stay was 34.7 days (range 21–77 days). There were four (20.9%) failures during the treatment
which required secondary amputation. During the treatment, one (5.3%) patient died due to multi-organ
failure after 27 days.


Conclusions
The use of NPWT therapy in the treatment of AKA stump complication is a safe and effective
procedure associated with low risk and positive outcome in terms of wound healing time and further
complications.