Skip to main content
SpringerLink
Log in

Wound dehiscence and stump infection after lower limb amputation: risk factors and association with antibiotic use

  • Original Article
  • Published:
Journal of Orthopaedic Science

Abstract

Background

Optimal duration of antibiotic prophylaxis following major lower limb amputation in preventing adverse stump outcomes is controversial.

Objective

We assess the epidemiology and risk factors of wound dehiscence and stump infection after mid-thigh to transmetatarsal amputations with regard to antibiotic administration.

Methods

Our retrospective observational study at the Geneva University Hospital (January 1995–June 2010) includes a total of 289 amputations in 270 adult patients (199 males; median age 70 years).

Results

Wound dehiscence and/or stump infection occurred in 47 (16.3 %) and 63 (21.8 %) patients with a median delay of 24 and 14 days, respectively. No clinical variable was significantly associated with stump infection. Diabetes and older age (>80 years) were associated with dehiscence. Importantly, transcutaneous tissue oxygen tension (TcPO2) and duration of antibiotic administration showed no association with either outcome.

Conclusion

The duration of antibiotic administration before or after surgery does not change the epidemiology of stump complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Karakoç A, Ersoy RU, Arslan M, Toruner FB, Yetkin I. Change in amputation rate in a Turkish diabetic foot population. J Diabetes Complicat. 2004;18:169–72.

    Article  PubMed  Google Scholar 

  2. Assal JP, Golay A. Patient education in Switzerland: from diabetes to chronic diseases. Patient Educ Couns. 2001;44:65–9.

    Article  PubMed  CAS  Google Scholar 

  3. Stone PA, Flaherty SK, Aburahma AF, Hass SM, Jackson JM, Hayes JD, Hofeldt MJ, Hager CS, Elmore MS. Factors affecting perioperative mortality and wound-related complications following major lower extremity amputations. Ann Vasc Surg. 2006;20:209–16.

    Article  PubMed  Google Scholar 

  4. Pollard J, Hamilton GA, Rush SM, Ford LA. Mortality and morbidity after transmetatarsal amputation: retrospective review of 101 cases. J Foot Ankle Surg. 2006;45:91–7.

    Article  PubMed  Google Scholar 

  5. Carmona GA, Lacraz A, Assal M. Walking activity in prosthesis-bearing lower-limb amputees. Rev Chir Orthop Reparatrice Appar Mot. 2007;93:109–15.

    Article  PubMed  Google Scholar 

  6. Krause FG, de Vries G, Meakin C, Kalla TP, Younger AS. Outcome of transmetatarsal amputations in diabetics using antibiotic beads. Foot Ankle Int. 2009;30:486–93.

    Article  PubMed  Google Scholar 

  7. de Godoy JM, Vasconcelos Ribeiro J, Andrioli Caracanhas L, Guerreiro Godoy MD. Hospital infection after major amputations. Ann Clin Microbiol Antimicrob. 2010;9:15.

    Article  PubMed  Google Scholar 

  8. Sadat U, Chaudhuri A, Hayes PD, Gaunt ME, Boyle JR, Varty K. Five day antibiotic prophylaxis for major lower limb amputation reduces wound infection rates and the length of in-hospital stay. Eur J Vasc Endovasc Surg. 2008;35:75–8.

    Article  PubMed  CAS  Google Scholar 

  9. Uçkay I, Harbarth S, Peter R, Lew D, Hoffmeyer, Pittet D. Preventing surgical site infections. Expert Rev Anti Infect Ther. 2010;8:657–70.

  10. McIntosh J, Earnshaw JJ. Antibiotic prophylaxis for the prevention of infection after major limb amputation. Eur J Vasc Endovasc Surg. 2009;37:696–703.

    Article  PubMed  CAS  Google Scholar 

  11. Uçkay I, Vernaz-Hegi N, Harbarth S, Stern R, Legout L, Vauthey L, Ferry T, Lübbeke A, Assal M, Lew D, Hoffmeyer P, Bernard L. Activity and impact on antibiotic use and costs of a dedicated infectious diseases consultant on a septic orthopaedic unit. J Infect. 2009;58:205–12.

    Article  PubMed  Google Scholar 

  12. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, Bell K, Caporusso J, Durand-Zaleski I, Komori K, Lammer J, Liapis C, Novo S, Razavi M, Robbs J, Schaper N, Shigematsu H, Sapoval M, White J, Clement D, Creager M, Jaff M, Mohler E 3rd, Rutherford RB, Sheehan P, Sillesen H, Rosenfeld K. Inter-Society consensus for the management of peripheral arterial disease (TASC II). Eur J Vasc Endovasc Surg. 2007;33:1–75.

    Article  Google Scholar 

  13. Berendt AR. Counterpoint: hyperbaric oxygen for diabetic foot wounds is not effective. Clin Infect Dis. 2006;43:193–8.

    Article  PubMed  CAS  Google Scholar 

  14. Owens WD, Felts JA, Spitznagel EL Jr. ASA physical status classifications: a study of consistency of ratings. Anesthesiology. 1978;49:239–43.

    Article  PubMed  CAS  Google Scholar 

  15. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.

    Article  PubMed  CAS  Google Scholar 

  16. Vittinghoff E, McCulloch CE. Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol. 2007;165:710–8.

    Article  PubMed  Google Scholar 

  17. Mueller MJ, Allen BT, Sinacore DR. Incidence of skin breakdown and higher amputation after transmetatarsal amputation: implications for rehabilitation. Arch Phys Med Rehabil. 1995;76:50–4.

    Article  PubMed  CAS  Google Scholar 

  18. Tracy GD, Lord RS, Hill DA, Graham AR, McGrath MA. Management of ischemia of the foot beyond arterial reconstruction. Surg Gynecol Obstet. 1982;155:377–9.

    PubMed  CAS  Google Scholar 

  19. Akıncı B, Yeşil S, Bayraktar F, Küçükyavaş Y, Yener S, Çömlekci A, Eraslan S. The effect of creatinine clearance on the short-term outcome of neuropathic diabetic foot ulcers. Primary Care Diabetes. 2010;4:181–5.

    Article  PubMed  Google Scholar 

  20. Adera HM, James K, Castronuovo JJ Jr, Byrne M, Deshmukh R, Lohr J. Prediction of amputation wound healing with skin perfusion pressure. J Vasc Surg. 1995;21:823–8.

    Article  PubMed  CAS  Google Scholar 

  21. Wutschert R, Bounameaux H. Determination of amputation level in ischemic limbs. Reappraisal of the measurement of TcPo2. Diabetes Care. 1997;20:1315–8.

    Article  PubMed  CAS  Google Scholar 

  22. Bunt TJ, Holloway GA. TcPO2 as an accurate predictor of therapy in limb salvage. Ann Vasc Surg. 1996;10:224–7.

    Article  PubMed  CAS  Google Scholar 

  23. Harbarth S, Samore MH, Lichtenberg D, Carmeli Y. Prolonged antibiotic prophylaxis after cardiovascular surgery and its effect on surgical site infections and antimicrobial resistance. Circulation. 2000;101:2916–21.

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

There are no consultancies, funding or affiliations that could lead to a conflict of interest for any of the authors listed in this article.

Author information

Authors and Affiliations

  1. Department of Infectious Diseases, Geneva University Hospitals & Medical School, University of Geneva, Geneva, Switzerland

    Nathalie Dunkel & Ilker Uçkay

  2. Orthopaedic Surgery Department, Geneva University Hospitals & Medical School, University of Geneva, 4, rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland

    Wilson Belaieff, Mathieu Assal, Valentina Corni, Alain Lacraz & Ilker Uçkay

  3. Department of Cardiovascular Surgery, Geneva University Hospitals & Medical School, University of Geneva, Geneva, Switzerland

    Şaziye Karaca

Authors
  1. Nathalie Dunkel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wilson Belaieff
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mathieu Assal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Valentina Corni
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Şaziye Karaca
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alain Lacraz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ilker Uçkay
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wilson Belaieff.

Additional information

N. Dunkel and W. Belaieff contributed equally as first authors.

About this article

Cite this article

Dunkel, N., Belaieff, W., Assal, M. et al. Wound dehiscence and stump infection after lower limb amputation: risk factors and association with antibiotic use. J Orthop Sci 17, 588–594 (2012). https://doi.org/10.1007/s00776-012-0245-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00776-012-0245-5

Keywords

Search

Navigation