An Analysis of Intraoperative, Early Postoperative, and Late Postoperative Application of Negative Pressure Wound Therapy in Below-Knee Amputations in a Tertiary Care Center.

BACKGROUND

Negative pressure wound therapy (NPWT) has been shown to improve wound healing through enhanced granulation tissue formation and exudate control. However, the timing of NPWT initiation in below-knee amputations (BKA) may significantly affect clinical outcomes, especially in resource-limited settings.

OBJECTIVE

This study aimed to evaluate the effect of intraoperative, early postoperative (within seven days), and late postoperative (after seven days) initiation of NPWT on wound healing parameters and length of hospital stay in patients undergoing BKA.

METHODS

A retrospective observational study was conducted on 75 patients who underwent BKA for diabetic foot complications. Patients were categorized into three groups (n = 25 each) based on the timing of NPWT initiation. Primary outcomes assessed were hospital stay duration and wound bed characteristics post-NPWT removal-granulation tissue percentage, slough percentage, wound contracture, and surrounding skin inflammation.

RESULTS

Intraoperative NPWT led to significantly better outcomes: higher granulation tissue (96.8%), lower slough (2%), and shorter hospital stay (mean 1.24 days) compared to early (84% granulation, 9.6% slough, and 2.2 days stay) and late (69.2% granulation, 17.6% slough, and 4.24 days stay) NPWT. Wound contracture and skin inflammation differences were not statistically significant.

CONCLUSION

Early application of NPWT, especially intraoperatively, accelerates wound healing and reduces hospitalization time in BKA patients. These findings suggest a cost-effective strategy for improving patient outcomes and optimizing healthcare resource utilization in developing countries.