Postoperative management of transtibial amputations in VA hospitals

Rigid plaster dressings and immediate postoperative prostheses (IPOP) in pa tients undergoing transtibial amputations have been reported to reduce pain and healing time, prevent knee flexion contractures, and expedite early am bulation compared to soft dressings. Yet, despite the reported benefits, su rgical adoption of (conventional) rigid dressings a.nd IPOP has been incons istent. The purpose of this study was to determine the current postoperativ e transtibial amputation dressing practices in VA hospitals. A six-item que stionnaire was sent to 134 surgeons at the 117 VA hospitals where transtibi al amputations were performed in fiscal year 1999. Responses were received from 83% of the surgeons. During the 1999 study year, surgeons performing t ranstibial amputations used soft dressings on 67% of patients, conventional rigid dressings with no intent to apply a foot attachment on 14% of patien ts, removable rigid dressings on 14% of patients, and IPOP (almost exclusiv ely without a foot) on 5% of patients. The application of a rigid dressing or IPOP did not correlate well with the total number of transtibial amputat ions performed by the surgeon, hospital bed size, or academic affiliation.