The effectiveness of rigid versus non-rigid dressings in reducing surgical site infections following major lower limb amputations: a systematic review

BACKGROUND: Surgical site infections (SSIs) are common complications following major lower limb amputation (MLLA), particularly among patients with diabetes and peripheral vascular disease. Postoperative dressing choice may influence SSI risk, yet the effect of rigid dressings (RDs) compared to soft dressings (SDs) on SSI risk is unknown. This review aimed to synthesise current literature analysing the effect of RDs versus SDs on SSIs and wound complications following MLLA. METHODS: This study was conducted according to PRISMA and Cochrane guidelines. Medline, Embase, CINAHL, CENTRAL, and ClinicalTrials.gov were searched from inception to January 2025. Eligible studies included randomised controlled trials (RCTs), observational studies, and case series reporting SSI rates after MLLA managed with RD or SD. Due to the limited number of RCTs and substantial heterogeneity, a planned meta-analysis was not feasible, and a narrative synthesis was conducted. Risk of bias was assessed using RoB 2, ROBINS-I, and JBI tools, and certainty of evidence was evaluated with GRADE. RESULTS: Ten studies (1 RCT, 6 observational, 3 case series) with 956 participants undergoing 1018 MLLAs were included. Reported SSI rates ranged from 0% to 77.8% in RD groups and from 13.5% to 65.9% in SD groups. The RCT demonstrated no significant difference in SSI rates between participants in the RD group (21.4%, 12/56) and the SD group (17.9%, 10/56), p = 0.47. Three observational studies reported lower SSI rates with RDs, while one reported higher rate. Wound dehiscence and revision surgery rates were generally lower in RD groups. Overall risk of bias was high across all studies, and no study reported SSIs as a primary outcome. Certainty of evidence was judged very low for all outcomes. DISCUSSION: While some studies suggest a potential benefit of rigid dressings in reducing postoperative complications, the current evidence does not support the superiority of rigid or non-rigid dressings for SSI prevention. Findings are limited by substantial heterogeneity, confounding, and inconsistent reporting. High-quality prospective studies with standardised outcome measures are urgently needed to inform clinical practice. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42024607144.