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Kwah LK1, Webb M2, Goh L3, Harvey L4
1Singapore Institute of Technology, Health and Social Sciences Cluster, Singapore, Singapore, 2South Eastern Sydney Local Heath District, South Eastern Sydney Local Heath District, Sydney, Australia, 3Bankstown Hospital, Department of Physiotherapy, Lidcombe, Australia, 4Kolling Institute, John Walsh Centre for Rehabilitation Research, Northern Sydney, Australia
Background: Soft dressings and rigid dressings are commonly used in the post-operative management of transtibial amputations. While soft dressings are cheaper and easier to apply, rigid dressings are believed to result in faster wound healing due to greater stump compression provided by the hard exterior. However, there are clinical concerns that rigid dressings might cause wound breakdown in patients with poor skin integrity. Previous systematic reviews have either not included recent evidence, measured important outcomes (e.g., adverse events), or considered the risk of bias in studies when drawing conclusions on the efficacy of rigid dressings for the management of transtibial amputations.
Purpose: The aim of the Cochrane systematic review was to assess the benefits and harms of rigid dressings versus soft dressings for treating transtibial amputations.
Methods: We searched several databases including the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL Plus, AMED, PEDro, clinical trial registries, the grey literature and the reference lists of relevant studies (up to August 2018). We also used the Cited Reference Search facility on ThomsonReuters Web of Science and contacted relevant individuals and organisations. We included trials that compared rigid dressings to soft dressings in people with transtibial amputations. Outcomes were wound healing, adverse events, prescription of prosthetics, physical function, length of hospital stay, patient comfort, quality of life, cost and swelling. Two authors independently screened for eligible studies, extracted data on study characteristics and outcomes, and performed risk of bias and GRADE assessments.
Results: We included results from nine trials involving 436 participants (441 limbs). Trials recruited participants from seven different countries (United States of America, Australia, Indonesia, Thailand, Canada, France and the United Kingdom). Rigid dressings included removable rigid dressings, non-removable rigid dressings and semi-rigid dressings, while soft dressings included elastic bandages, crepe bandages and soft bandages.
Significant differences were found between rigid and soft dressings for the outcomes: time to wound healing, time to readiness of prosthetic prescription, mean length of hospital stay and mean change in swelling (when measured less than one month). The differences were in favour of rigid dressings. However, we are uncertain about these significant results because results were based on a small number of studies (i.e., one to three studies of 21 to 65 participants) and all studies had severe methodological limitations in study design and execution. No significant differences were found between rigid and soft dressings for the outcomes: proportion of wounds healed, proportion of skin-related adverse events, proportion of non skin-related adverse events, mean time to no pain, mean time to walking and mean change in swelling (when measured within one to three months).
Conclusion(s): Due to limited and very low quality evidence, we remain uncertain if the use of rigid dressings leads to better or worse outcomes compared to soft dressings.
Implications: Clinicians should exercise clinical judgement and consider factors such as risk of falling and skin integrity when choosing one dressing over the other. High quality trials are now needed; researchers should aim to improve the conduct and reporting of future trials.
Keywords: Amputation, dressing, wound care
Funding acknowledgements:
None from Li Khim KWAH None from Matthew WEBB
None from Lina GOH
iCARE, NSW, Australia from Lisa HARVEY
Purpose: The aim of the Cochrane systematic review was to assess the benefits and harms of rigid dressings versus soft dressings for treating transtibial amputations.
Methods: We searched several databases including the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL Plus, AMED, PEDro, clinical trial registries, the grey literature and the reference lists of relevant studies (up to August 2018). We also used the Cited Reference Search facility on ThomsonReuters Web of Science and contacted relevant individuals and organisations. We included trials that compared rigid dressings to soft dressings in people with transtibial amputations. Outcomes were wound healing, adverse events, prescription of prosthetics, physical function, length of hospital stay, patient comfort, quality of life, cost and swelling. Two authors independently screened for eligible studies, extracted data on study characteristics and outcomes, and performed risk of bias and GRADE assessments.
Results: We included results from nine trials involving 436 participants (441 limbs). Trials recruited participants from seven different countries (United States of America, Australia, Indonesia, Thailand, Canada, France and the United Kingdom). Rigid dressings included removable rigid dressings, non-removable rigid dressings and semi-rigid dressings, while soft dressings included elastic bandages, crepe bandages and soft bandages.
Significant differences were found between rigid and soft dressings for the outcomes: time to wound healing, time to readiness of prosthetic prescription, mean length of hospital stay and mean change in swelling (when measured less than one month). The differences were in favour of rigid dressings. However, we are uncertain about these significant results because results were based on a small number of studies (i.e., one to three studies of 21 to 65 participants) and all studies had severe methodological limitations in study design and execution. No significant differences were found between rigid and soft dressings for the outcomes: proportion of wounds healed, proportion of skin-related adverse events, proportion of non skin-related adverse events, mean time to no pain, mean time to walking and mean change in swelling (when measured within one to three months).
Conclusion(s): Due to limited and very low quality evidence, we remain uncertain if the use of rigid dressings leads to better or worse outcomes compared to soft dressings.
Implications: Clinicians should exercise clinical judgement and consider factors such as risk of falling and skin integrity when choosing one dressing over the other. High quality trials are now needed; researchers should aim to improve the conduct and reporting of future trials.
Keywords: Amputation, dressing, wound care
Funding acknowledgements:
None from Li Khim KWAH None from Matthew WEBB
None from Lina GOH
iCARE, NSW, Australia from Lisa HARVEY
Topic: Neurology
Ethics approval required: No
Institution: Singapore Institute of Technology
Ethics committee: Singapore Institute of Technology
Reason not required: Not required for a systematic review.
All authors, affiliations and abstracts have been published as submitted.
