Healing of open stump wounds after vascular below-knee amputation: Plaster cast socket with silicone sleeve versus elastic compression

Objective: To assess the effect of a plaster cast socket on the healing of open wounds and on temporary prosthesis fitting after below-knee amputation because of arterial occlusive disease. Design: Randomized controlled trial. Setting: Rehabilitation center, university hospital. Patients: All included patients had undergone recent (in the previous 3 months) below-knee amputation because of arterial disease and initially had an open stump. Patients were randomly assigned to two groups of 28 subjects each. The sizes of the amputation scars were 8 to 24cm 2. Ischemia of the stump was eliminated as a probable cause of delayed wound healing by the inclusion criterion of transcutaneous oxygen tension (TcPo 2) of >35mmHg. The average age in group I (the experimental group) was 65.2 ± 12.4 (SD) years and in group II (the control group) 66.8 ± 10.8 years (not significant). Intervention: A plaster cast (supracondylar-type) socket was fitted on the stumps of group I patients, interposed with a silicone sleeve. The patients were gradually trained to wear this cast for up to 5 hours a day. They were provided with elastic compression bandages for the remainder of the time. Patients in group II wore elastic compression bandages, which were only removed for dressing changes. Main Outcome Measures: Time required for stump healing, length of time between amputation and ability to walk wearing a contact socket, and length of hospital stay. Results: Group I had a quicker average healing time (71.2 ± 31.7 [SD] days compared to the control group's 96.8 ± 54.9 days) and a shorter average length of hospital stay (99.8 ± 22.4 days compared to the control group's 129.9 ± 48.3 days). Conclusion: Use of a plaster cast socket leads to more rapid healing of the open stump and to a shorter hospitalization. If there is no stump ischemia, this plaster cast technique is safe.