History of Postoperative Prosthetics Surviving Lower Extremity Amputation - PowerPoint PPT Presentation

1 / 29
About This Presentation
Title:

History of Postoperative Prosthetics Surviving Lower Extremity Amputation

Description:

History. of. Postoperative Prosthetics. Surviving Lower Extremity Amputation ... Consistency of donning and doffing. Ability to add graded weight bearing ... – PowerPoint PPT presentation

Number of Views:368
Avg rating:3.0/5.0
Slides: 30
Provided by: johnrhe
Category:

less

Transcript and Presenter's Notes

Title: History of Postoperative Prosthetics Surviving Lower Extremity Amputation


1
History ofPostoperative Prosthetics Surviving
Lower Extremity Amputation
Robert N. Brown, Sr., CPO, FAAOP
2
4 Periods of General Medicine
  • 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

3
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)

4
Amputations Prosthetics
  • Silence until the 15th century
  • Middle Ages period of war
  • Amputations go largely unreported or
    forbidden
  • Castration
  • War continues to be the impetus for most
    prosthetic advances

5
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

6
Surviving Early Postoperative Care
  • Boiling oil (500 B.C.)
  • Control bleeding
  • Prevent infection
  • Blood Letting (Tabers Cyclopedia)
  • Eliminate disease
  • Leaches
  • Maggot Tx. (Stopped in the 20th Century)
  • Used to remove necrotic tissue
  • Cauterization
  • Heat, chemical, electrical laser

7
Advances in Medicine in the Modern Era
  • Ligatures (Ambroise Pare, 1529)
  • Tourniquet (Morel, 1674)
  • Chloriform Ether (1843)
  • Doppler Effect (early 1800s)
  • C. Doppler 1803 to 1853
  • Antiseptics (Lord Lister, 1867)
  • X-ray (Roentgen, 1895)
  • More

8
Post Amputation Concerns As
Technology Improves
  • 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

9
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

10
Advances In Amputation Surgery
  • Ertl Procedure
  • Periosteal juncture
  • X-ray
  • Schons Bridge
  • Ertl adaptation
  • Bone and screws

11
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

12
Postoperative Outcomes Continue to Improve with
  • Soft Dressings (SD)
  • Compression bandages
  • Shrinkers
  • Physical therapy
  • Occupational therapy
  • Psycho/Social therapy

13
Immediate PostOperative Prosthetics Early
PostOperative Prosthetics Arrive
  • Berlemont (late 1950s)
  • Modified by Weiss
  • Brought to the USA (1963)
  • Burgess/others adopt the technology

14
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)

15
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

16
Advantages of IPOP / EPOP
  • Protect wound site
  • Reduce falls
  • Speed-up the training and adjustment period
  • Improve balance and safety during transfers

17
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

18
Visual Trepidation
  • Bi-valved rigid removable dressing (Med. Journal
    Australia, Jones Buriston, 1970)
  • RRD (Wu 1979)
  • PSRD (Swanson 1993)

19
Pre-fabricated Sockets Systems
  • Postoperative Treatment of Lower Extremity
    Amputees (Brown, Danforth, Klotz, Schon others)

20
If It Aint 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

21
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

22
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)
  • Most systems are less bulky
  • Adjustability eliminates costly
    time consuming cast changes
  • Longer useful life

23
Pre-fabricated Removable IPOP Vs. Plaster or
Fiberglass
  • Adjust compression
  • Adjust wearing time
  • Shorter learning curve
  • 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

24
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

25
Available
Pre-fabricated Sockets Systems
  • Aircast Air-Limb --?
  • APOPPS-TF APOPPS by FLO-TECH ------?

26
More Pre-fabricated Postoperative Systems
Sockets
  • Danforth D-PASS -------?
  • Fillauer POP POP-PY -----------------?
  • TEC ------------------------?

27
Other Available Techniques Pre-fabricated
Systems
  • Plaster IPOP
  • Removable Rigid Dressing
  • RRD
  • PSRD
  • Una paste soft dressings
  • The Michigan Limb
  • Hosmer PP-AM
  • USMC Prep TT/TF
  • DeWindt limb
  • Ossur ----------?
  • Others custom

28
The Future Amputations on the Rise
  • 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

29
Conclusion
  • Not enough qualified prosthetists to meet demand
  • Prosthetists time better spent on
    surgeon/rehab team/patient relationships
    on mentoring young prosthetists
  • Pre-fabricated systems reproduce quality from
    one prosthetist, one IPOP, to the next
Write a Comment
User Comments (0)
About PowerShow.com