Acute Care

Rigid Dressings

Rigid dressings have been used as best practice for post-operative stump management for many years. They come in 2 flavours: non removable thigh length casts, which protect the stump and maintain the knee in extension; and removable rigid dressings which enclose the stump to just below the knee, thus allowing the amputee to have knee flexion, and are easily removable to allow inspection of the stump.

Rigid dressings are used with the following aims in mind:

• Prevention of the build up of post-operative oedema.
• Protection of the stump from trauma (falls or knocks).
• Provide a closed environment for wound healing.
• Minimise dressing changes, thus protect the healing surgical wound.
• Minimise movement at the wound edges, promoting healing and preventing risk of dehiscence.
• Protect the stump from exposure / infection.
• Reduces pain by supporting the stump.
• Prevention of knee flexion contracture (thigh-length only).

Removable rigid dressings have the added advantages of:

• Ease of application: once casted, can be re-applied by the amputee themself, or other staff.
• Can be easily removed for inspection of the wound / stump.
• Allows maintenance of knee range of motion.
• Is easily adjustable to fluctuations in stump size through packing with stump socks.

In NSW in 2008, the NSW DOH released a guideline, Amputee Care - The Use of Post-Operative Rigid Dressings for Trans-Tibial Amputees, in conjunction with a Policy Directive, Amputee Care Standards in New South Wales. These documents recommended the use of rigid dressings for all transtibial amputees. Significant work was done by the Prosthetic Limb Service, in conjunction with Physiotherapists, Rehabilitation Specialists, and surgeons, in promoting the use of rigid dressings for post-operative management of amputees. The PLS has also released numerous documents and fact sheets on the use of rigid dressings, at www.enable.health.nsw.gov.au/home/publications.

Rigid Dressings (Non removable)

• Fact Sheet produced by the NSW ALS on fabrication of non removable rigid dressings (2009): Fabrication of Non-Removable Rigid Dressings
• www.ampsurg.org. Site containing videos of amputation surgery, by Dr Douglas Smith. Includes application of an RD intra-operatively.

Removable Rigid Dressings

• Fact Sheets produced by the NSW Prosthetic Limb Service, on fabrication and management of removable rigid dressings (2009):
• Fabrication of removable rigid dressings.
• Nursing Information for Removable Rigid Dressings.
• Patient Information for Removable Rigid Dressings.

See also the documents listed in the sidebar, for information on evidence for the use of rigid dressings, and techniques for manufacture and fitting.