PRE PROSTHETIC TREATMENT FOR FRESH TRANSFEMORAL AMPUTEE

Pre Prosthetic treatment
Is the care done before the use of any prosthetic or other assistive device

Goal of Pre Prosthetic Treatment

to maintain a good shape and good position of stump for fitting an artificial limb

steps to be taken

  • Ensure uncomplicated wound healing
  • Control edema
  • Maintaining good range of motion
  • Prevent or reduce joint contractures
  • Maintain muscle strength
  • Desensitization
  • Skin Mobility
Methods
  • Desensitization
  • Skin mobility
  • Soft Dressing
  • Rigid Dressing
  • Bandaging
  • Elastic Stump Socks
  • Shrinker Socks
  • Elevation
  • Exercises
  • Education to patient

Desensitization
It is Decreasing or lessening sensitivity
Tell patient to gently touch their stump with firm pressure just after amputation
brushing with soft cloth

gentle tapping
Be careful not to interfere with the healing in the acute (early) phase before stitches are removed and the incision is completely healed. Begin after this phase.

Skin Mobility
skin should not stuck to the underlying bone by scar tissue
Other wise, abnormal pressure and rubbing of this skin and bone against the inside of the socket of the prosthesis might happen.

How?

  • skin over the bones of the stump

press down gently & firmly, move in small circle

  • skin around and over the incision

move side to side & move in small circle

Soft Dressing
It is a dressing coated with soft materials as an adhesive or a wound contact layer
The properties soft materials are such that these dressings may be removed without causing trauma to the wound or to the surrounding skin.

Soft Dressing materials

  • absorbent paste
  • pieces of soft gauze
  • gauze roll (for wrap over)
  • elastic bandage (secure the soft gauze and control edema)

Advantages Soft Dressing

  • It is Easy to apply
  • Low cost
  • It is easy accessibility to the wound.
  • It supports the amputated site under the compressive pressure.

Disadvantages of Soft Dressing

  • it requires frequent changing and close monitoring to maintain the correct amount of pressure.
  • It is easy to loosen and fall off.

Rigid Dressing
It is a mildly total contact wrapping applied to the stump using rigid materials.

Material:

  • Plaster of Paris
  • DynaCast
  • Thermoplastic materials

Purpose
to provides rapid residual limb shrinkage, prevents edema, provides soft tissue immobilization, decreases wound pain and prevents trauma to the residual limb

Dry wound surface should be maintain
The dressing should be properly suspended to maintain distal pressure.
Placing a compressible material such as foam or distal pads at the site of surgery helps maintain distal pressure.

Disadvantages Of Rigid Dressing

  • It prohibits frequent inspection
  • Any complications will require cast (dressing) removal

Bandaging

  • It is dressing with textile bandages applied in successive turns (circular, figure-of-eight or spiral to the stump)
  • It is used to support the soft tissues
  • Patient & / patient attendances needs to learn bandaging. and then do by himself / herself, Or at least they must be familiar with bandaging.

Purpose of Bandaging

  • To reduce or prevent swelling / edema
  • Prevention of contractures.
  • Procedure of Bandaging

Advantages of Bandaging

  • It lays itself to all stump sizes and forms.
  • It is effective and economical.
  • It protects and support the stump
  • It can be taken off easily for clinical examination and stump cleaning.

Disadvantages of Bandaging

  • Slipping of the bandage distal end edema
  • Difficulty on obtaining pressure distribution
  • Too tight
  • Too loose


Elastic Stump Socks

  • Made up of elastic materials.
  • available in different sizes
  • Their fitting is exact due to elastic materials.
  • They are less likely to wrinkle and cause a tourniquet effect.

Advantages of Elastic Stump Socks

  • It can be put on and take off easily.
  • Clinical control and cleaning of the stump can be done without complications.

Disadvantages of Elastic Stump Socks

  • not available in all sizes
  • weak upper limb dexterity always have difficulties
  • It should not be used over the bandage

Shrinker Socks:
It is a type of elastic stump sock
used for healed stump having edema.

Elevation
keeping the stump in a position higher in level than the rest of the body.
the stump is raised above the heart level to facilitate the back flow of blood.
Amputation results in cutting of the muscles that helps back flow of the blood.

  • Proper position avoid any contracture deformity.
  • keeping feet of the bed higher than head level.
  • keeping a pillow under patient’s stump
  • prone position extension avoid hip flexion contracture


Exercises

  • keep the muscles active
  • regain the lost strength
  • prevent deformities due to muscle weakness
  • Active contraction of antagonist muscles helps in venous blood return.
  • Hip flexion & extension
  • Hip adduction & abduction
  • Weight bearing exercises.
  • Fresh stump cannot bear load, so one must press it to exercise it for weight bearing.
  • regular intervals.

Any amputee having strong and well coordinated muscles
give bright prosthetic future life.
able for sustaining a self suspended socket
indicate for free knee joint mechanism.

Education to the patient

  • Postural Position
  • During Standing
  • Sitting Position
  • Lying Position



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