SRS168 - A systematic review and meta-analysis of rigid versus soft dressings in the management of major lower limb amputations

Background 4000 major lower limb amputations (MLLA) are performed in the UK each year. The residual limb is usually bandaged with soft dressings (SD), to augment wound healing, pain control and reduce swelling. Rigid dressings (RD) may reduce the incidence of wound complications. This study aims to compare RD versus SD in patients who have undergone MLLA. Methods A literature search was conducted in OVID Medline, EMBASE, CINAHL and the Cochrane CENTRAL databases. Study selection was restricted to randomised clinical trials (RCTs) comparing RD against SD in English. The primary outcome was a composite of wound complications defined as infection, dehiscence, failure of wound healing, collection, or amputation related readmission within 30 days or re-operation within 90 days. Secondary outcomes included time to wound healing and prosthetic fitting, length of hospitalisation, post-procedural pain, and patient satisfaction. Results 9 RCTs were included in this review. RD did not reduce wound complications compared with SD (risk ratio 0.85, 95% confidence interval [c.i.] 0.46 to 1.85, P = 0.41). RD reduced time to healing (mean difference 17.2 days, 95% c.i. 4.22 to 30.15, P = 0.01) and prosthetic fitting (mean difference 12.1 days, 95% c.i. 1.78 to 22.37, P = 0.02) compared with SD. There was no difference between RD and SD in length of hospitalisation, post-procedural pain, and patient satisfaction. The majority of the studies were considered at significant risk of bias. Conclusions RD did not reduce wound complications in patients undergoing MLLA. However, time to wound healing and prosthetic fitting is shorter with RD.