Wound Complications And Reoperations Following Transtibial Amputation Of The Leg.

Abstract Background Transtibial amputation (TTA) of the leg has been associated with high rates of wound complications. We assessed outcomes of TTAs to determine if bundled interventions implemented at our hospital had an impact on lowering wound complications, including surgical site infections (SSIs). Methods We assessed the impact of an SSI prevention bundle (negative pressure wound therapy, minimizing the use of staples, and a decontamination protocol for methicillin-resistant Staphylococcus aureus) on 90 day wound complications. The year of implementation of the prevention bundle was excluded, and the pre- and post-eras were defined as four-year period before and the four-year period after implementation. The study sample consisted of a single-center cohort, with TTA cases identified using operating room scheduling software. Results A total of 182 TTAs were performed: 110 in the pre-era and 72 in the post-era. The wound complication rate decreased from 22% to 17% despite fewer two-stage operations, less imaging to identify peripheral artery disease, and an increased proportion of patients with end-stage renal disease. Wound complications and revision to a higher level of amputation were more associated with indication (esp. no-option peripheral artery disease with ischemic rest pains) than with any particular aspect of surgical technique. The use of drains was associated with reoperations but not higher-level revision. Conclusions Higher rates of wound complications and of revision to a higher level of amputation should be expected among patients with no-option peripheral artery disease with ischemic rest pains undergoing TTA. Drains should be avoided.