Transcript REMOVABLE RIGID DRESSING Katrina Brown, Senior Physiotherapist Greenwich Hospital Presented at NSW PAR Meeting Nov.

REMOVABLE RIGID
DRESSING
Katrina Brown, Senior Physiotherapist
Greenwich Hospital
Presented at NSW PAR Meeting Nov. 2004
Postop Mx of Residual Limb
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Soft dressings
Thigh Level Rigid Dressing
Removable Rigid Dressings
Prosthetic liners (ICEROSS)
Acute Care of Residual Limb with RRD
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AIM:
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Reduce oedema
Protection for residual limb (RL)
Promote wound healing
Reduce pain
Shape residual limb
First Introduced by Wu (1979).
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Reduce/prevent
oedema
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Non-expandible
dressing
Protection
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Distal aspect of RL
often used for
stabilisation in bed
mobility and transfers
High risk of falls
Reduced sensation in
dysvascular patients
Benefits of RRD
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Reduction in or prevention of oedema
Promotes wound healing
Allows access to wound for inspection and dressing
changes
Education of patient starts re. donning/doffing
Permits knee flexion
Ability to adjust fit
Protects RL while healing
Quick & easy to make
? Cost effective
Research out there
Smith et al. (2003). Postoperative dressing and
management strategies for transtibial
amputees: A critical review.
Literature review
 Body of RCT evidence poor
 Mueller (1982)
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Significantly less oedema (compared with soft dressing)
Wu et al. (1979)
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Reduction in healing time from 109.5 days to 46.2 days
(compared with soft dressing)
Research out there
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Maclean & Fick 1994
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Deutsch et al. (unpublished). Presentd at
ISPO 2002.
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Trend towards earlier prosthetic fitting
Trend towards faster healing time
Indications in prevention of trauma in event of fall
Woodburn et al. 2004
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Trend towards limb reduction but not statistically significant.
Limitations with study
Fabrication of RRD with
“Shapemate”
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Ensure low profile dressing
Padding can be added for relief areas as required
Apply sock and cover with plastic bag or glad wrap
Have sock/bag held taught or use suspender strap
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Soak sock and unravel portion to assist in donning
Fold at mid patella tendon allowing enough at back
of cast to allow knee flexion
Alternatively trim off above knee and fold twice to
create collar
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Continue down with roll to create second layer for
added protection
Trim off excess and smooth to avoid rough edges
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No excess moulding required
Keep moist to assist curing process
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Once hard to tap, mark front centre and remove to
dry
Allow time for curing process and then towel off
excess moisture
Re-apply to patient, with sock underneath
Removable Rigid Dressing
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Use tubigrip to
suspend, or lightweight
sock with thigh strap to
secure
Add socks as required
to maintain fit
Monitor for pressure
Hints for “Shapemate”
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Ensure malleable in packet before opening
Cool storage temperatures can be
problematic.
Soap can assist in emulsion
Enough material for double layer adding
further protection
References
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Smith et al (2003). “Postoperative dressing and management
strategies for transtibial amputations: A critical Review.” Journal of
rehab. Research and Development, 40 (3), 213-224, May/June.
Woodburn et al (2004). “A randomised trial of rigid stump dressing
following trans-tibial amputation for peripheral artery insufficiency.”
Prosthetics and Orthotics International, 28, 22-27.
Deutsch et al (2002). “Removable rigid dressings versus soft
dressings: A randomised study with dysvascular trans-tibial
amputees.” Proceedings of the ISPO ANMS Annual Scientific
Meeting, Alice Springs NT June 2002.
Wu, Y. (1992). Removable Rigid Dressing for Residual Limb
Management. In L. Karacoloff, C. Hammersley & F. Schreider
(Eds.). Lower extremity Amputation: A guide to Functional
Outcomes in Physical Therapy Management. Second Edition.
Gaithersburg: Aspen Publication.
Maclean & Fick 1994. “The Effect of Semirigid Dressings on BelowKnee Amputations.” Physical Therapy, 74(7), 668-672.
Special thanks to Reis Orthopaedics, for
supply of “Shapemate”.
25 John Street Lidcome. Ph: 9643 1444