A Survey of Perioperative Management of Major Lower Limb Amputations: Current UK Practice

Background: A Quality Improvement Framework has been formulated aiming to reduce the perioperative mortality of patients undergoing major lower limb amputations as this is unacceptably high. Surgical site infections (SSI) have a significant impact on the morbidity and mortality of this group of patients. This study aimed to establish whether consensus exists among UK consultant vascular surgeons regarding perioperative management of major lower limb amputations and review current evidence regarding the prevention of SSI. Methods: A postal questionnaire, which had previously been piloted, was sent to consultant members of the Vascular Society. It comprised 17 questions to establish their current perioperative practice and the estimated incidence of SSI within their patient cohort. The chi-squared test was used to establish the impact of skin preparation, dressings, and closure technique on infection rates. Results: A total of 168 consultants responded to the questionnaire-a response rate of 37.2%. The median-reported infection rate was in the range of 6-10%. 95.8% of respondents always give antibiotics. The majority of respondents use aqueous betadine (44.6%). The majority of respondents close the skin with subcuticular continuous sutures (58.3%). The preferred dressing for both above-and below-knee amputations was a stump bandage (62.5% and 61.9%, respectively). No statistically significant difference was seen in the reported infection when examined in relation to skin preparation, closure method, or dressings used. Conclusions: It appears that there is currently little consensus on the perioperative management of patients undergoing major lower limb amputation. Further studies in the form of randomized control trials are required to facilitate decision making and optimize patient outcome.