Revision of failed below knee amputations. Local debridement with gentamicin collagen.

OBJECTIVE

To describe our results with a new technique of revision of failed below knee amputation stumps using gentamicin impregnated collagen sponge.

DESIGN

Open study.

SETTING

District hospital.

SUBJECTS: 31 patients who underwent below knee amputations between 1988 and 1992, compared with 31 historical controls who were operated on between 1984 and 1988.

INTERVENTIONS: Two thirds of the stumps that failed to heal underwent excision of necrotic and devitalised tissue; half had shortening of tibia and fibula and a gentamicin impregnated collagen sponge was left in the wound, which was then closed.

MAIN OUTCOME MEASURES: Successful wound healing and rehabilitation.

RESULTS

12 Stumps failed to heal, 8 of which were suitable for local treatment with the gentamicin sponge. All 8 healed satisfactorily, though one required revision of the scar 6 months later. Of the remainder, the stumps were converted to above knee amputations (n = 3) and one was disarticulated at the knee. In the control group 5 of the 7 stumps in which healing failed, were converted to above knee amputations and the other two healed after split skin grafting.

CONCLUSION

We think that local treatment with the collagen sponge with gentamicin offers a viable alternative to conversion to above knee amputation for below knee amputation stumps that fail to heal. The treatment should now be subjected to a randomised controlled trial.