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RESIDUAL LIMB ULCER MANAGEMENT IN LEG AMPUTEES 117

OR (transtibial OR “trans-tibial”)) OR (tran- were not included initially through title and abstract
spelvic OR “trans-pelvic”)) OR (syme’s OR screening. Articles not meeting inclusion criteria
symes))) AND ((((“Amputation”[Mesh]) OR were eliminated. Included articles were then evalu-
amput*) OR disarticulation) OR (hemipelvec- ated using the American Academy of Orthotists and
tomy OR “hemi-pelvectomy”)))) OR stump)) NOT Prosthetists’ (AAOP) evidence rating tool because of
((((((((pirogoff) OR chopart) OR lisfranc) OR its content and population specificity (8). This rating
(transmetatarsal OR “trans-metatarsal”)) OR “ray tool was also selected because it permits evaluation
resection”) OR “ray resections”) OR “ray amputa- of the full range of manuscripts and study designs
tion”) OR “ray amputations”))) AND (ulcer OR (i.e., editorials to meta-analyses). The AAOP rating
ulcerat* OR pressure sore OR pressure ulcer OR tool identifies 18 potential threats to internal valid-
decubit* OR breakdown)) AND (intervention OR ity and eight potential threats to external validity of
treatment OR management OR non-use OR dress- the included experimental, quasi-experimental, and
ing OR negative pressure OR wound vacuum). observational research articles reviewed (Table 1).
Following review and rating, internal and external
Inclusion criteria were based on the definition of validity were then classified as “high,” “moderate,” or
prosthesis-related ulcer and LEA as defined by the “low.” Articles were classified as having high internal
authors. Prosthesis-related ulceration, as defined by or external validity if they met >80% of the tool’s cri-
the authors, referred to an uninfected wound on the teria, moderate internal or external validity if they
RL of a patient with an LEA that occurred from exces- met 60% to 80% of criteria, and low internal or exter-
sive pressure associated with prosthetic use. In this nal validity if they met <60% of the criteria (Table 2).
review, LEA referred to any Syme’s, transtibial, knee
disarticulation, transfemoral, hip disarticulation, or RESULTS
hemipelvectomy amputation of any etiology. Foot
and toe amputations were excluded. To be included, The search identified 3,024 peer-reviewed arti-
manuscripts were required to: cles (Figure 1). Studies involving animal, cadaver,
or modeling; written before January 1, 1990; and/or
1. Include subjects with a lower extremity ampu- not written in English were excluded. Additionally,
tation and a prosthesis-related ulcer on their articles were eliminated based on title when the title
residual limb(s) failed to reasonably support manuscript inclusion.
2. Be published after 1990
3. Study interventions, treatments, or manage- Table 1. Distribution of Included Studies by Study Design
Table 1. Distribution of Included Studies by Study Design
ment of wounds or ulcers in the amputated Number of
residual limb(s) of a person with lower Study Design Publications
extremity amputation who has used or uses Meta-Analysis (S1) 0
Systematic Review
0
a prosthesis Randomized Control Trial (E1) 1
Manuscripts were excluded if they were: Controlled Trial (E2) 0
Interrupted Time Series Trial (E3) 0
1. Studies involving animals, cadavers, or com- Single-Subject Trial (E4) 0
putational modeling (i.e., non-human) Controlled Before and After Trial (E5) 0
2. Published before January 1, 1990 Cohort Study (O1) 1
0
Case-Control Study (O2)
3. Not written in English Cross-Sectional Study (O3) 0
Search results were exported into Endnote reference Qualitative Study (O4) 0
management software (V7, Thompson, CA, USA). Case Series (O5) 1
Case Study (O6)
2
Once imported, reference titles and then abstracts Group Consensus (X1) 0
were screened for inclusion. Full text articles were Expert Opinion (X2) 0
then obtained for review of remaining articles that Total 5