Transcript Aircast Air-Limb™ - Flo

History
of
Postoperative Prosthetics
Surviving Lower Extremity Amputation
Robert N. Brown, Sr., CPO, FAAOP
4 Periods of
General Medicine
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Antiquity Period
– 2000 B.C. to 500 A.D.
Middle Ages
– 500 A.D. to 1400 A.D.
Renaissance Period
– 1400 A.D. to 1846
The Period of Modern Surgery
– 1846 to 20th Century
New Era?
• Ertl Procedure and Adaptations
Amputations & Prosthetics
 Surgical
amputation
– Stone Age - 3,000 B.C.

Pre-dates prosthetics
 First
recorded prosthesis 484 B.C.
– 500 years after the first recorded
orthosis
 Oldest
prosthesis 300 B.C.
– Destroyed in the bombing of
London, W. W. II)
Amputations & Prosthetics
 Silence
century
until the 15th
– “Middle Ages” period of war
Amputations go largely
unreported or forbidden
 Castration

 War
continues to be the impetus
for most prosthetic advances
Early Surgical Efforts

The operation was a success but 75%
of all amputees died

Surgeons lacked knowledge
– Asepsis
 Sterile conditions
– Ligation
 Ligature to stop bleeding of
severed blood vessels
Surviving Early Postoperative Care

Boiling oil
(500 B.C.)
– Control bleeding
– Prevent infection

Blood Letting
(Taber’s Cyclopedia)
– Eliminate disease
– Leaches

Maggot Tx.
(Stopped in the 20th Century)
– Used to remove necrotic tissue

Cauterization
– Heat, chemical, electrical & laser
Advances in Medicine in the
Modern Era
Ligatures (Ambroise Pare, 1529)
 Tourniquet (Morel, 1674)
 Chloriform & Ether (1843)
 Doppler Effect (early 1800’s)
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
C. Doppler 1803 to 1853
Antiseptics (Lord Lister, 1867)
 X-ray (Roentgen, 1895)
 More

Post Amputation Concerns
– As Technology Improves
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Pain
Death
Infection
Contractures
Pressure sores
Psychological trauma
Adequate blood supply
Edema/shrinkage/swelling
Changes in transected bones
Neuroma formation/sensory loss
Desire to return to a “Normal Life”
Advances in Amputation Surgery

Guillotine

Contoured flaps
– Suturing techniques
– “Good Surgical Technique
Creates A Functional
Residual Limb.” (Thomas &
Hadden, 1945)

Extended posterior flap
(late 1960s)
– Doppler
Advances In Amputation
Surgery

Ertl Procedure
– Periosteal juncture
 X-ray

Schon’s Bridge
– Ertl adaptation
 Bone and screws
Postoperative Outcomes
Continue to Improve with:
Bed rest
 Light compression &
early & continuous skin
Traction (Barnard 1942)
 Wound drainage

– Hema-vac systems

Surgical & suturing
methods
– Staples
Postoperative Outcomes Continue
to Improve with:

Soft Dressings (SD)
– Compression bandages
– Shrinkers

Physical therapy

Occupational therapy

Psycho/Social therapy
Immediate PostOperative
Prosthetics & Early
PostOperative Prosthetics
Arrive
 Berlemont (late 1950’s)
 Modified
by Weiss
– Brought to the USA (1963)

Burgess/others adopt the
technology
“It Is Mandatory That The Surgeon
Understand Prosthetic Principles &
Available Components.”
(Ernest M. Burgess, M.D., 1967)

PSAS (Prosthetics & Sensory Aides Service
[V.A]) & PRS (Prosthetics Research Study)
– IPOP (Burgess, Romano, Traub,
Zettle/Van Zandt/Gardner, May 1964 to
November 1966)

Independent studies of the positive
and negative results of IPOP (Titus,
Wilson & many others)
Why Immediate or Early
Prosthetic Management?
 Improves
outcomes
 Helps with challenging cases
 Enhances the value of rehab care
 Maximizes potential for future prosthetic
use
 “Functional Management” empowers
patient, family & rehab team
Advantages of IPOP / EPOP

Protect wound site
 Reduce falls
 Speed-up the training
and adjustment period
 Improve balance and
safety during transfers
Advantages of IPOP / EPOP

Patient gets more initial attention
 Reduce other health complications
 Reduce length of hospital stay
 Psychological benefits
– Re-establish bilateral function & body image
– Psycho-social acceptance of prosthesis to
become a functioning prosthetic user
Visual Trepidation

Bi-valved rigid
removable dressing
(Med. Journal Australia, Jones
& Buriston, 1970)

RRD (Wu 1979)

PSRD (Swanson 1993)
Pre-fabricated Sockets
& Systems
 Postoperative
Treatment of
Lower Extremity
Amputees
(Brown, Danforth, Klotz,
Schon & others)
If It Ain’t Broke, Why Fix It?
- Plaster IPOP Lacks:
Opportunity for surgeon to
examine limb to preserve
wound integrity and quality
 Opportunity for Therapists
to examine residuum before
& after weight bearing
 Ability to shrink and swell
with the patient
 Ability to reproduce a
quality outcome from one
practitioner or one IPOP to
another

Why Use a Pre-fabricated Removable
IPOP Vs. Shrinker or Ace Wrap (SD)?

Minimize skin breakdown
 More effective edema control
 Ability to keep knee in extension
 Consistency of donning and doffing
 Ability to add graded weight bearing
 More rapid maturation of residual limb
 Protection of residual limb from trauma
 Immobilizing soft tissue promotes healing
Why Use a Pre-fabricated Removable
IPOP Over Plaster or Fiberglass?

“To remove all opportunity to watch the wound is
not reasonable.” (Kerstein, Zimmer, &
Dugdale, article IPOP - Poor Results - 1972)
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Most systems are less bulky
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Adjustability eliminates costly &
time consuming cast changes
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Longer useful life
Pre-fabricated Removable IPOP
Vs. Plaster or Fiberglass

Adjust compression
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Adjust wearing time
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Shorter learning curve
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Definitive components used
– Can be reused by the same patient

Eliminates cast changes & realignment
– Surgeon, prosthetist & patient save time

Can get wet or soiled and can be cleaned
Disadvantages of Pre-fabricated
Removable IPOP / EPOP

Could be removed
 Not for every patient
 Could be incorrectly donned
 Weight bearing must be controlled
 Bulky relative to a custom made
preparatory
 Complications may be blamed on
the socket or system
 More initial material cost than plaster IPOP
Available
Pre-fabricated
Sockets & Systems

Aircast Air-Limb™ --

APOPPS-TF™ & APOPPS™
by FLO-TECH® ------
More Pre-fabricated
Postoperative Systems & Sockets
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Danforth – D-PASS -------
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Fillauer POP & POP-PY -----------------

TEC ------------------------
Other Available Techniques &
Pre-fabricated Systems

Plaster IPOP
 Removable Rigid Dressing
– RRD
– PSRD
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Una paste soft dressings
The Michigan Limb
Hosmer PP-AM
USMC Prep TT/TF
DeWindt limb
Ossur ----------
Others & custom
The Future – Amputations on the Rise
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Cost of Rehab (Malone, Pipinich, Leal, Hayden &
Simpson, Maricopa Medical Center Study)
– Non IPOP - $47,589
– IPOP - $28,432 - adjusted ($42,535)

56,000 amputations per yr. - Diabetes
(1997, American Diabetes Association)

90% of limb amputations in the western
world are consequences of PVD/Diabetes
 Rest of world - not far behind
– Land mines
 Especially children
Conclusion

Not enough qualified prosthetists to meet
demand

Prosthetists time better spent on
surgeon/rehab team/patient relationships
& on mentoring young prosthetists
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Pre-fabricated systems reproduce quality
from one prosthetist, one IPOP, to the next