The incidence of pressure sores following lower limb amputations

Abstract

In a retrospective survey of lower limb amputations (diabetic major amputations n=34, minor n=33; non-diabetic major 28, minor 27), pressure sores developed following 55% of major and 20% of minor amputations (p<0.001). Sores developed after major amputations in 68% of diabetic but in only 39% of non-diabetic patients (p=0.018). The incidence of sores after minor operations did not differ between the two groups. After major amputations sacral sores were more common in diabetic than in non-diabetic patients (59 versus 36%, p=0.041), but the incidence of heel ulcers was similar. The mean age of patients developing sores was greater than in those who did not, in both diabetic (p<0.025) and non-diabetic patients (p<0.01). Peripheral vascular disease appeared to be a more important risk factor than neuropathy for pressure sore development. Sores were no more common after epidural or spinal than after general anaesthesia. The Waterlow score was a poor predictor of the risk of developing a sore. The incidence of sores was not related to pre-operative creatinine or albumin concentrations, but was greater in those whose haemoglobin concentration on the first or second post-operative day was < 10 g/dL (p=0.015). In conclusion, pressure sores are very common following amputation and especially so after major amputations in diabetic patients. All potential amputees should be managed as being at high risk of developing sores. Copyright © 2001 John Wiley & Sons, Ltd.