There are a number of options for early post-operative care for amputees, depending on the medical provider preferences, the amputee’s unique medical condition, and other factors, such as insurance coverage. Here is a breakdown of the most common early post-operative options:
Soft dressing
· Includes ACE wrapping, gel liners, and stump shrinkers
· Can reduce swelling, pain, protect wound and help shape residual limb
One of the most common and effective soft dressings is the stump shrinker, which is a soft compression sock that fits snuggly onto the residual limb. Stump shrinkers are available in different designs and materials. ACE wraps can be applied while the sutures/staples are still in, whereas the stump shrinker and gel liners are typically ordered by a physician once the sutures/staples have been removed, to avoid wound care issues and infection. Rarely, a physician may request for a stump shrinker to be applied prior to removal of the sutures/staples. In these unique situations, it is imperative for the residual limb to be examined thoroughly and frequently.
Rigid dressing
· Rigid plaster wrapping
· Fiberglass wrapping
· Can service as ‘socket’ for immediate and early post-operative prosthetic design, which includes a prosthetic foot
· Can reduce swelling, contractures, pain and protect wound
· Does not allow for frequent and easy inspection of residual limb
Removable rigid dressing
· Combination of soft & rigid dressing
· Removable
· Prosthetic socks can be added to maintain close fit
· Lower trim lines than standard rigid dressing for below the knee amputation, which allows for better range-of-motion in the knee
· Typically not used as ‘socket’ for immediate or early post-operative prosthetic design
· Exercise and limited weight bearing (on bed/chair) can be initiated
Semi-rigid dressing
· Composed of a flexible plastic and used with stump shrinker
· Easier donning/doffing
· More comfortable
· Can be used with staples/sutures in place
IPOP: Immediate post-operative prosthesis
· Applied immediately following surgery
· A rigid dressing with prosthetic components (foot) attached
· Has all properties of rigid dressing, while also allowing for limited weight bearing/ambulation following surgery
· Controls contractures
EPOP: Early post-operative prosthesis
· Typically applied 5-7 days following surgery
· Can be composed of various components designs
· Accommodates rapid anatomical change
· Provides cushioning of residual limb
· Assists in wound healing and residual limb maturation
· Reduces post-surgical swelling and pain
· Allows for early ambulation
· Controls contractures
· Should be used only for limited sessions throughout the day and require frequent limb inspection
· Weight bearing should be minimal and depends on the amputee’s tolerance
· Weight bearing and wearing time can be increased gradually, depending on wound healing an user tolerance
The success of early prosthetic care is directly related to proper wearing protocol and effective communication among all involved medical staff. Skin breakdown and other complications, such as infection, can result if proper protocol is not followed closely.
Removable designs not only meet the needs of the surgeon, but also benefit the entire rehabilitation process. The prosthetist is allowed to make adjustments to accommodate for volume changes and to aid in limb shaping. The physical therapist is allowed to perform strengthening and range of motion exercises to the knee. The result is faster healing and a greater chance for successful rehabilitation.