Rigid dressings versus soft dressings for transtibial amputations

摘要: BACKGROUND Dressings are part of the routine postoperative management people after transtibial amputation. Two types dressings commonly used; soft (e.g. elastic bandages, crepe bandages) and rigid non-removable dressings, removable immediate protheses). Soft conventional dressing choice as they cheap easy to apply, while costly, more time consuming apply require skilled personnel dressings. However, have been suggested result in faster wound healing due hard exterior providing a greater degree compression stump. OBJECTIVES To assess benefits harms versus for treating amputations. SEARCH METHODS In December 2018 we searched Cochrane Wounds Specialised Register, Central Register Controlled Trials (CENTRAL), Ovid MEDLINE, Embase, EBSCO CINAHL Plus, AMED PEDro identify relevant trials. further published, unpublished ongoing studies, also clinical trial registries, grey literature, reference lists studies reviews identified prior searches. We used Cited Reference Search facility on ThomsonReuters Web Science contacted individuals organisations. There were no restrictions with respect language, date publication or study setting. SELECTION CRITERIA included randomised controlled trials (RCTs) quasi-RCTs that enrolled age participants reasons compared effectiveness main focus this review. DATA COLLECTION AND ANALYSIS review authors independently screened titles, abstracts full-text publications eligible studies. extracted data characteristics outcomes, performed risk bias GRADE assessments. MAIN RESULTS nine RCTs involving 436 (441 limbs). All recruited from acute and/or rehabilitation hospitals seven different countries (the USA, Australia, Indonesia, Thailand, Canada, France UK). all but one study, it was clearly stated amputations secondary vascular conditions.Primary outcomes Wound uncertain whether decrease (MD -25.60 days; 95% CI -49.08 -2.12; 56 participants); very low-certainty evidence, downgraded twice high once serious imprecision. It is not clear increase proportion wounds healed (RR 1.14; 0.74 1.76; 51 imprecision.Adverse events skin-related adverse 0.65; 0.32 1.32; I2 = 0%; six 336 (340 limbs)); imprecision.It non 1.09; 0.60 1.99; 342 (346 addition, pain -0.35 weeks; -2.11 1.41; 23 imprecision.Secondary outcomesWe walking -3 -9.96 3.96; length hospital stay -30.10 -49.82 -10.38; readiness prosthetic prescription swelling results based once/twice serious/very None reported patient comfort, quality life cost. AUTHORS' CONCLUSIONS undergoing amputation limited evidence. if superior improving related healing, events, prescription, function, swelling. Clinicians should exercise judgement which type use, consider pros cons each patients falling may benefit protection offered by dressing, poor skin integrity less breakdown dressing).