Poor wound healing following a major lower limb amputation can result in poor rehabilitation outcomes, which can be further worsened if the patient has recurrent falls and stump trauma during the wound healing stage. Direct trauma to the stump can result in bony fractures at the margins of the residual bones, and loose bony fragments may form inside the stump. These bony fragments can hinder the process of stump wound healing and interfere with prosthetic limb use and rehabilitation.
Case Description and Methods
We report this unusual case of 54 years old female patient who had a poor postoperative stump wound healing following a direct stump trauma due to a fall during the early postoperative recovery phase. She failed to respond to several weeks of conservative treatment.
A plain radiograph of the stump showed several body fragments migrated from a fracture at the distal tibial margin. A few weeks later, the patient noticed a sizeable body fragment spontaneously fell from the unhealed area of the stump. Shortly following this, her incisional wound showed signs of complete healing.
Outcomes and Conclusion
We think that this bony spur is the most likely culprit behind the patient's unusually prolonged wound healing. We discussed this case at the local MDT meeting in order to share the knowledge amongst the team and to raise vigilance about the need for early investigations in similar scenarios, particularly following direct trauma to the amputation residuum.