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AMPUTEES
AN OVERVIEW
SANZIDA HOQUE
Limited literature
Only RCT/ CT on silicone and corticosteroids
Not specific to the amputee population
Other recommendations are low level expert
advice
SCAR MANAGEMENT
SURGICAL
Tension releasing or excision, has a high risk of reoccurrence when not used in
conjunction with corticosteroid and silicon gel sheeting
CORTICOSTEROID INJECTION
Inhibits protein synthesis, diminishes tissue deposition and softens scars
LASER THERAPY
Flattening of scars seen in 57- 83% of cases
CRYOTHERAPY
Liquid nitrogen to affect cell microvasculature, flattens scars in 51- 74% of cases
COMPRESSION
Stretches tight collagen, results inconclusive, used in burns
HEAT THERAPY
Ultrasound, hot packs, wax, to increases tissue extensibility
SILICONE GEL SHEETING
Good evidence with 8 RCTs
PHARMACOLOGICAL
NSAIDs, Antihistamines, Interferons
SCAR MANAGEMENT contd
MASSAGE
Commonly used with
amputees no RCT/ CT
found
Recommended 5- 10 min
3-4 times/ day
Decreases oedema
Breaks down scar tissue
blocks
Increases capillary
proliferation and healing
Assists desensitisation
Re hydrates scar tissue
(use of vitamin E cream is
mentioned but no
evidence)
REFERENCES
“Wound healing complications associated with lower limb
amputation” Harker J. (2006)
“Phases of wound healing” Fishman T. D. (1995)
“Stump management after trans-tibial amputation: A systematic
review” Nawijn et al. (2005) Prosthetics and orthotics
international
“Early treatment of trans-tibial amputees: Retrospective analysis
of early fitting and elastic bandaging” Van Velzen et al. (2005)
Prosthetics and orthotics international
“Silicon gel sheeting for preventing and treating hypertrophic and
keloid scars” O’Brien L. and Pandit A. (2007) Cochrane database
of systematic reviews
“Musculoskeletal complications in amputees: Their prevention and
management” Bovvker et al. chapter 25, Atlas of limb prosthetics:
surgical, prosthetic, and rehabilitation principles
“A clinical evaluation of stumps in lower limb amputees”
Pohjolainen T. (1991) Prosthetics and orthotics international
REFERENCES contd
“Adherent cicatrix after below-knee amputation” Lilja M and
Johansson T. (1993) Journal of prosthetics and orthotics
“The use of silicone liners in early prosthetic rehabilitation. A pilot
trial” Anandan P. (2003) orthotic and prosthetic services Tasmania
“Stump ulcers and continued prosthetic limb use” Salawu et al.
(2006) Prosthetics and orthotics international
“A primer on ace wrapping and other compressive and protective
dressings for the amputated residual limb” Highsmith J.
“Healing of open stump wounds after vascular below-knee
amputation: plaster cast socket with silicone sleeve vs. elastic
compression” Vigier et al. (1999) American congress of
rehabilitation medicine….
“International clinical recommendations on scar management”
Mustoe et al. (2001)
http://www.amputee-coalition.org/military-instep/wound-skin-
care.html
“Scar management” Naude L. (2006) Wound Care