Ulcers and their treatment in patients after amputation
DOI:
https://doi.org/10.14528/snr.2021.55.2.2987Keywords:
skin damage, treatment, nursingAbstract
Introduction: The most common causes affecting the healing of ulcers in patients after amputation are associated with peripheral arterial disease, diabetes and chronic venous insufficiency. The purpose of the study was to identify the factors that may affect the healing of the ulcer on the amputation stump.
Methods: Quantitative non-experimental research methodology was used. A retrospective study was performed by reviewing the nursing documentation on ulcer monitoring. The study included 134 patients with an ulcer after amputation of the lower limb, hospitalized in 2017. Descriptive statistics and logistic regression were used.
Results: 134 patients had ulcers caused by various factors. In comparison to men, women are more expected to have ulcers at discharge (OR = 4.8, 95 % CI: 1−22), and patients who had an ulcer before the hospitalization (OR = 7.7, 95 % CI: 3−19.2) as well as those with more than one ulcer (OR = 4.7, 95 %, CI: 1−22.3). Patients who had an ulcer on the amputation stump, had lower prospects for the presence of ulcers at discharge from the hospital (OR = 0.2, 95 % CI: 0.1−0.6, p = 0.004).
Discussion and conclusion: The findings suggest that at discharge women are more likely to have an ulcer at discharge than men. Also, patients with ulcers at admission and patients with multiple ulcers at admission are more likely to have an ulcer at discharge. A survey including more patients should be conducted. Also, exact monitoring parameters should be specified.
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Anderson, J. J., Boone, J., Hansen, M., Spencer, L., & Fowler, Z. (2012). A comparation of diabetic smokers and non-diabetic smokers who undergo lower extremity amputation: A retrospective review of 112 patients. Diabetic Foot & Ankle, 3, 1–4. https://doi.org/10.3402/dfa.v3i0.19178 PMid:23082237; PMCid:PMC3474996
Anugraha, A., Jehangir, N., Alqubaisi, M., Rafee, A., Kurdy, N., & Pillai, A. (2020). End-capping of amputation stump with a local antibiotic containing hydroxyapatite bio-composive: A report of 13 cases with chronic lower limb osteomyelitis. Journal of Orthopaedics, 17, 124−126. https://doi.org/10.1016/j.jor.2019.11.007 PMid:31879490; PMCid:PMC6919344
Armstrong, D. G., & Meyr, A. J. (2018a). Basic principles of wound management. UpToDate. Retrieved December 4, 2018 from https://www.uptodate.com/contents/basic-principles-ofwound-management/print
Armstrong, D. G., & Meyr, A. J., (2018b). Risk factors for impaired wound healing and wound complications. UpToDate. Retrieved December 4, 2018 from https://www.uptodate.com/contents/risk-factors-for-impaired-wound-healing-andwound-complications
Bommer, C., Heesemann, E., Sagalova, V., Manne-Goehler, J., Atun, R., Bärnighausen, T., & Vollmer, S. (2017). The global economic burden of diabetes in adults aged 20−79 years: A cost of illness study. The Lancet Diabetes & Endocrinology, 5(6), 423−430. https://doi.org/10.1016/S2213-8587(17)30097-9 PMid:28456416
Brown, A. (2015). Phases of the wound-healing process. Nursing times, 111(46), 12−13. Cavassan, N. R. V., Camargo, C. C., Pontes, L. G., Barraviera, B., Ferreira, R. S., Miot, A. M., Abbade L. P. F., & Delazari dos Santos, L. (2018). Correlation between chronic venous ulcer axudate proteins and clinical profile: A cross sectional study.
Journal of Proteomics, 192, 280−290. https://doi.org/10.1016/j.jprot.2018.09.009 PMid:30261322
Diniz, I. V., de Oliveira, P. S., Santos, I. C. R. V., de Oliveira Matos, S. D., Costa, I. K. F., Costa, M. M. L., & Oliveira
Soares, M. J. G. (2019). Factors associated with non-traumatic amputation in people with diabetes mellitus: A cross-sectional study. Review Electronic Enfermera, 21, 1−9. https://doi.org/10.5216/ree.v21.52484
Frykberg, R. G., & Banks, J. (2015). Challanges in the treatment of chronic wounds. Advances in Wound Care, 4(9), 560−582. https://doi.org/10.1089/wound.2015.0635 PMid:26339534; PMCid:PMC4528992
Guest, J. F., Ayoub, N., Mcllwraith, T., Julian, F., Uchegbu, I., Gerrish, A., Weidlich, D., Vowden, K., & Vowden, P. (2015). Health economic burden that wounds impose on the National Health Service in the UK. BMJ Open, 5(12), 1−8. https://doi.org/10.1136/bmjopen-2015-009283 PMid:26644123; PMCid:PMC4679939
Guo, S., & DiPietro, L. A. (2010). Factors affecting wound healing. Journal of Dental Research, 89(3), 219−229.
https://doi.org/10.1177/0022034509359125 PMid:20139336; PMCid:PMC2903966
Hall, J., Buckley, H. L., Lamb, K., Stubbs, N., Saramago, P., Dumville, J. C., & Cullum, N. A. (2014). Point prevalence of complex wounds in a defined United Kingdom population. Wound Repair Regen, 22 (6), 694–700.
https://doi.org/10.1111/wrr.12230 PMid:25224463
Hasanadka, R., McLafferty, R. B., Moore, C. J., Hood, D. B., Ramsey, D. E., & Hodgson, K. J. (2011). Predictors of wound complications following major amputation for critical limb ischemia. Journal of Vascular Surgery, 54(5), 1374–1382. https://doi.org/10.1016/j.jvs.2011.04.048 PMid:21840153
Heyer, K., Herberger, K., Protz, G., & Glaeske, M. A. (2016). Epidemiology of chronic wounds in Germany: Analysis of statutory health insurance data. Wound Repair Regen, 24(2), 434–442. https://doi.org/10.1111/wrr.12387 PMid:26609788
Highsmith, M. J., Kahle, J. T., Klenow, T. D., Andrews, C. R., Lewis, K. L., Bradley., R. C. ... Highsmith, J. T. (2016).
Interventions to manage residual limb ulceration due to prosthetic use in individuals with lower extremity amputation: A systematic review of the literature. Technology and Innovation, 18(2/3), 115−123.
https://doi.org/10.21300/18.2-3.2016.115 PMid:28066521; PMCid:PMC5218523
Iqbal, A., Jan, A., Wajid, M. A., & Tariq, S. (2017). Management of chronic non-healing wounds by hirudotherapy. Wound Journal of Plastic Surgery, 6(1), 9−17.
Junichi, S., Shigerz, S., Kazuyoshi, H., Takashi, U., Tsukasa, S., Ryui, H. ... Saito, N. (2012). A retrospective, longitudinal study to evaluate healing lower extremity wounds in patients with diabetes mellitus and ischemia using standard protocols of care and platelet-rich plasma gel in a Japanese Wound Care Program. Ostomy Wound Management, 58(4), 36−49. PMid:22466132
Kamrad, I., Söderberg, B., Örneholm, H., & Hagberg, K. (2020). SwedeAmp-the Swedish amputation and prostetics registry: 8-year data on 5762 patients with lower limb amputation show sex differences in amputation level and in patient-reported outcome. Acta Orthopaedica, 91(4), 464−470. https://doi.org/10.1080/17453674.2020.1756101 PMid:32316805
Koichi, M., Terutoshi, Y., & Kazuomi, I. (2018). Risk factors for wound complications and 30-day mortality after major lower limb amputations in patients with peripheral arterial disease. Vascular, 26(1), 12–17. https://doi.org/10.1177/1708538117714197 PMid:28587576
Kodeks etike v zdravstveni negi in oskrbi Slovenije in Kodeks etike za babice Slovenije. (2014). Ljubljana: Zbornica zdravstvene in babiške nege Slovenije – Zveza strokovnih društev medicinskih
sester, babic in zdravstvenih tehnikov Slovenije
Liu, M., Zhang, W., Yan, Z., & Yuan, X. (2018). Smoking increases risk of diabetic foot amputation: A meta-analysis. Experimental and Therapeutic Medicine, 15(2), 1680−1685. https://doi.org/10.3892/etm.2017.5538
Meulenbelt, H. E. J. (2010). Skin problems of the stump in lower limb amputees (pp. 128−131). University of Groningen, Groningen.
Meulenbelt, H. E. J., Dijkstra, P. U., Jonkman, M. F., & Geertzen, J. H. B. (2006). Skin problems in lower limb amputees: A systematic review. Disability & Rehabilitation, 28(10), 603–608. https://doi.org/10.1080/09638280500277032 PMid:16690571
Meulenbelt, H. E. J., Geertzen, J. H., Jonkman, M. F., & Dijkstra, P. U. (2009). Determinants of skin problems of the stump in lower limb amputees. Archived of Physical Medicine and Rehabilitation, 90(1), 74−81. https://doi.org/10.1016/j.apmr.2008.07.015 PMid:19154832
Meulenbelt, H. E. J., Geertzen, J. H., Jonkman, M. F., & Dijkstra, P. U. (2011). Skin problems of the stump in lower limb amputees: 1.a clinical study. Acta Dermato Venereologica, 91(2), 173−177.
https://doi.org/10.2340/00015555-1040 PMid:21290085
Mills, J. L., Conte, M. S., Armstrong, D. G., Pomposelli, F. B., Schanzer, A., Sidawy, A. N., & Andros, G. (2014). The society for vascular surgery lower extremity threatement limb classification system: Risk stratification based on wound ischemia, and foot infection (Wlfl). Journal of Vascular Surgery,
(1), 220−234. https://doi.org/10.1016/j.jvs.2013.08.003 PMid:24126108
Moore, Z., Butcher, G., Corbett, L. Q., McGuiness, W., Snyder, R. J., & van Acker, K. (2014). Exploring the concept of a team approach to wound care: Managing wounds as a team. Journal of Wound Care, 23(Suppl. 5b), S1−S38. https://doi.org/10.12968/jowc.2014.23.Sup5b.S1 PMid:25191792
Nealon, R. S., Howe, P. R., Jansen, L., Garg, M., & Wong, R. H. (2017). Impaired cerebrovascular responsiveness and cognitive performance in adults with type 2 diabetes. Journal of Diabetes
and Its Complications, 31(2), 462–467. https://doi.org/10.1016/j.jdiacomp.2016.06.025 PMid:27431891
Newbern, S. (2018). Identifying pain and effects on quality of life from chronic wounds secondary to lower-extremity vascular disease: An integrative rewiew. Advances in Skin & Wound Care, 31(3), 102−108. https://doi.org/10.1097/01.ASW.0000530069.82749.e5 PMid:29438143
Oliverio, J., Gero, E., Whitacre, K. L., & Rankin, J. (2016). Wound care algorithm: Diagnosis and treatment. Advances in Skin & Wound Care, 29(2), 65–72. https://doi.org/10.1097/01.ASW.0000473132.88076.af PMid:26765158
Pađen, L. (2014). Kakovost življenja bolnika s kronično razjedo. In: D. M. Smrke & Nikolič J. (Eds.), 9. simpozij o ranah – sodobni pristopi za učinkovito zdravljenje okuženih kirurških in kroničnih ran, Portorož, 24. do 25. april, 2014 (pp. 91−95). Ljubljana: Klinični oddelek za kirurške okužbe, Kirurška
klinika, Univerzitetni klinični center Ljubljana.
Pastar, I., Stojadinovic, O., Yin, N. C., Ramirez, H., Nusbaum, A. G., Sawaya, A. … Tomic-Canic, M. (2014). Epithelialization in wound healing: A comprehensive review. Advances in Wound Care (New Rochelle), 3(7), 445–464. https://doi.org/10.1089/wound.2013.0473 PMid:25032064; PMCid:PMC4086220
Polfer, E. M., Hoyt, B. W., Senchak, L. T., Murphey, M. D., Forsberg, J. A., & Potter, B. K. (2014). Fluid collections in amputations are not indicative or predictive of infection. Clinical Orthopaedics and Related Research, 472(10), 2978−2983. https://doi.org/10.1007/s11999-014-3586-x PMid:24691841; PMCid:PMC4160471
Price, B., Moffatt, B., & Crofts, D. (2015). Managing patients following a lower limb amputation. Journal of Clinical Nursing, 29(3), 26–33.
Raya, M. A., Gailey, R. S., Fiebert, I. M., & Roach, K.E. (2010). Amputation impairment variables predicting activity limitation in individuals with lower limb. Prosthetics and Orthotics International, 34(1), 73−83. https://doi.org/10.3109/03093640903585008 PMid:20196689
Reiber, G. E., McFarland, L. V., Hubbard, S., Maynard, C., Blough, D. K., Gambel, J. M., & Smith, D. G. (2010). Servicemembers and veterans with major traumatic limb loss from Vietnam war and OIF/OEF conflicts: Survey methods, participants, and summary findings. Journal of Rehabilitation Research & Development, 47(4), 275–298. https://doi.org/10.1682/JRRD.2010.01.0009 PMid:20803399
Rink, C., Wernke, M. M., Powell, H. M., Gynawali, S., Schroeder, R. M., Kim, J. Y. ... Chandan, S. K. 2016). Elevated vacuum suspension preservesresidual-limb skin health in people with lower-limb amputation: Randomized clinical trial. Journal of Rehabilitation Research & Development, 53(6), 1121−1132. https://doi.org/10.1682/JRRD.2015.07.0145 PMid:28355039
Rocha, D. M., Bezerra, S. M. G., Andrade, E. M. L. R., Santos, A. M. R., & Nogueira, L. T. (2019). Quality of lihe of people with chronic wounds. Acta Paulista de Enfermagem, 32(2), 1−9.
Salomé, G. M., Almeida, S. A., Pereira, M. T. J., Massahud, M. R., Moreira, C. N., Brito, M. J. ... Masako, L. (2016). The impact of venous leg ulcers onbody image and self-esteem. Advances in Skin & Wound Care, 29(7), 316−321. https://doi.org/10.1097/01.ASW.0000484243.32091.0c PMid:27300362
Salawu, A., Middelton, C., Gilbertson, A., Kodavali, K., & Neumann, V. (2006). Stump ulcers and continued prosthetic limb use. Prosthetics and Orthotics International, 30(3), 279−285.
https://doi.org/10.1080/03093640600836139 PMid:17162518
Tabatabaei-Malazy, O., Mohajeri-Tehrani, M. R., Pajouhi, M., Shojaei Fard, A., Amini, M. R., & Larijani, B. (2010). Iranian diabetic foot research network. Advances in Skin & Wound Care, 23(10), 450−454.
https://doi.org/10.1097/01.ASW.0000383222.79771.93 PMid:20859075
Turns, M. (2011). The diabetic foot: An overview of assessment and complications. British Journal of Nursing, 20(15), S19–S25. https://doi.org/10.12968/bjon.2011.20.Sup8.S19 PMid:21841646
Urbančič, V., & Slak, M. (2017). Pregled diabetičnega stopala. Retrieved November 16, 2018 from http://endodiab.si/priporočila/diabetična-noga/pregled-stopala/
Wadwhani, S. (2007). Prevalence of stump problems in a community sample of lower limb amputees. Leeds: Leeds Medical School SSM project.
Whiting, D. R., Guardiguata, L., Weil, C., & Shaw, J. (2011). IDF diabetes atlas: Global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Research and Clinical Practice, 94(3), 311−321.
https://doi.org/10.1016/j.diabres.2011.10.029 PMid:22079683
World Medical Association. (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. Journal of the American Medical
Association, 310(20), 2191–2194. Retrieved from http://www.wma.net/en/20activities/10ethics/10helsinki/DoH-Oct2013-JAMA.pdf PMid:24141714
Yang, N. B., Garza, L. A., Foote, C. E., Sewon Kang, S., & Meyerle, J. H (2012). High prevalence of stumpdermatoses 38 years or more after amputation. Archives of Dermatology, 148(11), 1283–1286.
https://doi.org/10.1001/archdermatol.2012.3004 PMid:23165833; PMCid:PMC4429883
Zhang, P., Lu, J., Jing, Y., Tang, S., Zhu, D., & Bi, Y. (2017). Global epidemiology of diabetic foot ulceration: A systematic review and meta-analysis. Annals of Medicine, 49, 106–116. https://doi.org/10.1080/07853890.2016.1231932 PMid:27585063
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