{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T05:11:00Z","timestamp":1786770660464,"version":"build-2736575974"},"reference-count":38,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2017,10,18]],"date-time":"2017-10-18T00:00:00Z","timestamp":1508284800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PM&amp;R"],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:label\/><jats:p>Forty years of clinical experience and peer\u2010reviewed research studies support the use of nonweight\u2010bearing removable rigid dressings (RRDs) as an effective means of postoperative management of transtibial amputations. We reviewed the published medical evidence regarding the use of RRDs as a postoperative management strategy, culminating in an evidence\u2010based practice recommendation. Published peer\u2010reviewed literature on the topic was searched and classified by level of evidence based on the research design using the scale recommended by the <jats:italic>PM&amp;R<\/jats:italic> (level I through V). The search uncovered a total of 15 articles, including 5 level I randomized controlled trials, 6 level III retrospective matched controlled trials, and 4 level V case reports.<\/jats:p><jats:p>A number of benefits associated with the application of RRDs compared with soft dressings were reported across these 15 studies. These included faster healing times, reduced limb edema, preparatory contouring of the residual limb in anticipation of prosthetic use, the prevention of knee flexion contractures, and reduced external trauma to the limb. Also described were an increased probability of successful prosthetic use and pain reduction. The RRDs studied permitted regular inspection of surgical wounds with greater ease and consistency of application than traditional soft dressing approaches. Rigid dressings provide all the same benefits of RRDs except ease of wound inspection, therefore rendering them impractical for the 82% of patients receiving an amputation for ischemic disease that are at high risk of developing wound dehiscence. Weight\u2010bearing immediate postoperative prostheses are almost exclusively reserved for use on trauma patients who usually do not show evidence of vascular or neurologic impairment. The inherent risks of falls and inconsistent pressure on the surgical wound have further restricted their use in practice to a limited patient type.<\/jats:p><jats:p>The benefits of RRDs compared with soft dressings are universally recognized in the published peer\u2010reviewed medical evidence to be superior to soft dressings. Based on the best\u2010available current published evidence, nonweight\u2010bearing removable rigid dressings should be considered the first treatment choice for the postoperative care of transtibial amputees to optimize outcomes with regard to reductions in injury due to falls, knee flexion contractures, edema, healing time, time to prosthetic fitting, and pain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>II<\/jats:p><\/jats:sec>","DOI":"10.1016\/j.pmrj.2017.10.002","type":"journal-article","created":{"date-parts":[[2017,10,18]],"date-time":"2017-10-18T19:47:05Z","timestamp":1508356025000},"page":"516-523","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Removable Rigid Dressings for Postoperative Management of Transtibial Amputations: A Review of Published Evidence"],"prefix":"10.1002","volume":"10","author":[{"given":"James P.","family":"Reichmann","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip M.","family":"Stevens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Rheinstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher D.","family":"Kreulen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,10,18]]},"reference":[{"key":"e_1_2_6_2_2","first-page":"213","article-title":"Postoperative dressing and management strategies for transtibial amputations: A critical review","volume":"40","author":"Smith D.G.","year":"2003","journal-title":"J Rehabil Res Dev"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1080\/17461550500066832"},{"key":"e_1_2_6_4_2","first-page":"27","volume-title":"Atlas of Amputations and Limb Deficiencies: Surgical, Prosthetic, and Rehabilitation Principles","author":"Smith D.","year":"2004"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2014.05.002"},{"key":"e_1_2_6_6_2","doi-asserted-by":"crossref","first-page":"22","DOI":"10.3109\/03093640409167921","article-title":"A randomized trial of rigid stump dressing following trans\u2010tibial amputation for peripheral arterial insufficiency","volume":"28","author":"Woodburn K.R.","year":"2004","journal-title":"Prosthet Orthot Int"},{"key":"e_1_2_6_7_2","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1080\/17461550500069588","article-title":"Early treatment of trans\u2010tibial amputees: Retrospective analysis of early fitting and elastic bandages","volume":"29","author":"Velzen A.D.","year":"2005","journal-title":"Prostet Orthot Int"},{"key":"e_1_2_6_8_2","doi-asserted-by":"crossref","first-page":"241","DOI":"10.2106\/00004623-197153020-00004","article-title":"Comparison of postoperative stump management: Plaster vs. soft dressings","volume":"53","author":"Mooney V.","year":"1971","journal-title":"J Bone Joint Surg Am"},{"key":"e_1_2_6_9_2","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1097\/00003086-196801000-00016","article-title":"Immediate postsurgical fitting and early ambulation","volume":"56","author":"Golbranson F.L.","year":"1968","journal-title":"Clin Orthop Rel Res"},{"key":"e_1_2_6_10_2","first-page":"992","article-title":"The deleterious effect of immediate postoperative prosthesis in the below\u2010knee amputation for ischemic disease","volume":"76","author":"Cohen S.I.","year":"1974","journal-title":"Surgery"},{"key":"e_1_2_6_11_2","first-page":"244","article-title":"The rigid versus soft postoperative dressing controversy: A controlled study in vascular below\u2010knee amputees","volume":"46","author":"Kane T.J.","year":"1980","journal-title":"Am Surg"},{"key":"e_1_2_6_12_2","first-page":"293","article-title":"Postoperative management of the transtibial amputations in VA hospitals","volume":"38","author":"Choudrey S.R.","year":"2001","journal-title":"J Rehabil Res Dev"},{"key":"e_1_2_6_13_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200301000-00001"},{"key":"e_1_2_6_14_2","first-page":"435","volume-title":"Gangrene and Severe Ischemia of the Lower Extremities","author":"Wu Y.","year":"1978"},{"key":"e_1_2_6_15_2","unstructured":"D.Kinor E.Gaussa E.Sutton.Alternative to soft dressings: A review.The O & P EdgeDecember 2013"},{"key":"e_1_2_6_16_2","doi-asserted-by":"crossref","first-page":"724","DOI":"10.2106\/00004623-197961050-00013","article-title":"An innovative removable rigid dressing technique for below\u2010the\u2010knee amputation","volume":"61","author":"Wu Y.","year":"1979","journal-title":"J Bone Joint Surg Am"},{"key":"e_1_2_6_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/62.10.1438"},{"key":"e_1_2_6_18_2","first-page":"51","article-title":"Porous removable rigid dressing for complicated below\u2010knee amputation stumps","volume":"68","author":"Gandhavadi B.","year":"1987","journal-title":"Arch Phys Med Rehabil"},{"key":"e_1_2_6_19_2","first-page":"128","article-title":"Rigid removable dressing in case of poor wound healing","volume":"69","author":"Richter K.J.","year":"1988","journal-title":"Arch Phys Med Rehabil"},{"key":"e_1_2_6_20_2","first-page":"4","article-title":"The use of rigid removable dressings for juvenile amputees: A case report","volume":"26","author":"Gendron B.","year":"1991","journal-title":"J Assoc Child Prosthetic\u2010Orthotic Clin"},{"key":"e_1_2_6_21_2","first-page":"1438","article-title":"Use of removable rigid dressing for transtibial amputees rehabilitation: A Greenwich Hospital experience","volume":"62","author":"Hughes S.","year":"1998","journal-title":"Aust Physiother"},{"key":"e_1_2_6_22_2","doi-asserted-by":"publisher","DOI":"10.1191\/0269215504cr738oa"},{"key":"e_1_2_6_23_2","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1080\/03093640500224295","article-title":"Removable rigid dressings versus soft dressings: A randomized, controlled study with dysvacular, trans\u2010tibial amputees","volume":"29","author":"Duetsch A.","year":"2005","journal-title":"Prosthet Orthot Int"},{"key":"e_1_2_6_24_2","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1080\/03093640600554732","article-title":"Removable rigid dressings versus soft dressings","volume":"30","author":"Emmelot C.H.","year":"2006","journal-title":"Prosthet Orthot Int"},{"key":"e_1_2_6_25_2","first-page":"22","article-title":"Use of a polyethylene removable rigid dressing in a transtibial amputee","volume":"10","author":"Tsai P.","year":"2007","journal-title":"J Australasian Rehabil Nurs Assoc"},{"key":"e_1_2_6_26_2","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1097\/JPO.0b013e31802d42c2","article-title":"Results of managing transtibial amputations with a prefabricated polyethylene rigid removable dressing","volume":"19","author":"Ladenheim E.","year":"2007","journal-title":"J Prosthet Orthot"},{"key":"e_1_2_6_27_2","doi-asserted-by":"publisher","DOI":"10.1080\/17453670710015265"},{"key":"e_1_2_6_28_2","doi-asserted-by":"publisher","DOI":"10.1080\/03093640802016795"},{"key":"e_1_2_6_29_2","first-page":"1441","article-title":"Comparison of removable rigid dressing and elastic bandages in reducing the volume of the residual limb knee amputees below","volume":"91","author":"Janchai S.","year":"2008","journal-title":"J Med Assoc Thai"},{"key":"e_1_2_6_30_2","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/j.avsg.2011.08.001","article-title":"Early protection and compression of residual limbs may improve and accelerate prosthetic fit: A preliminary study","volume":"26","author":"Duwayri Y.","year":"2012","journal-title":"Ann Vasc Surg"},{"key":"e_1_2_6_31_2","doi-asserted-by":"crossref","first-page":"16","DOI":"10.13181\/mji.v22i1.516","article-title":"Efficacy of removable rigid dressing after transtibial amputation in diabetes mellitus patients","volume":"22","author":"Hidayati E.","year":"2013","journal-title":"Med J Indones"},{"key":"e_1_2_6_32_2","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1016\/j.avsg.2013.03.007","article-title":"A comparison of immediate postoperative rigid and soft dressings for below\u2010knee amputations","volume":"27","author":"Sumpio B.","year":"2013","journal-title":"Ann Vasc Surg"},{"key":"e_1_2_6_33_2","doi-asserted-by":"publisher","DOI":"10.1053\/apmr.2001.24295"},{"key":"e_1_2_6_34_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.phm.0000219119.58965.8c"},{"key":"e_1_2_6_35_2","first-page":"753","article-title":"Major stump trauma following below\u2010knee amputation. Outcome and recommendations for therapy","volume":"32","author":"Behar T.A.","year":"1991","journal-title":"J Cardiovasc Surg (Torino)"},{"key":"e_1_2_6_36_2","first-page":"276","article-title":"Femoral fractures in patients with lower extremity amputations","volume":"61","author":"Gonzolez E.G.","year":"1980","journal-title":"Arch Phys Med Rehabil"},{"key":"e_1_2_6_37_2","first-page":"22","article-title":"Fractures in amputation stumps: Review of treatment of 16 fractures","volume":"56","author":"Lewallen R.P.","year":"1981","journal-title":"Mayo Clin Proc"},{"key":"e_1_2_6_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(99)80133-8"},{"key":"e_1_2_6_39_2","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.avsg.2014.09.008","article-title":"Re: do rigid dressings reduce the time from amputation to prosthetic fitting? A systematic review and meta\u2010analysis","volume":"29","author":"Reichmann J.P.","year":"2015","journal-title":"Ann Vasc Surg"}],"container-title":["PM&amp;R"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1016%2Fj.pmrj.2017.10.002","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1934148217303076?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1934148217303076?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.pmrj.2017.10.002","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,14]],"date-time":"2023-09-14T22:14:17Z","timestamp":1694729657000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1016\/j.pmrj.2017.10.002"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,10,18]]},"references-count":38,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2018,5]]}},"alternative-id":["10.1016\/j.pmrj.2017.10.002"],"URL":"https:\/\/doi.org\/10.1016\/j.pmrj.2017.10.002","archive":["Portico"],"relation":{},"ISSN":["1934-1482","1934-1563"],"issn-type":[{"value":"1934-1482","type":"print"},{"value":"1934-1563","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,10,18]]},"assertion":[{"value":"2017-03-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-10-04","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-10-18","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}