Saturday, May 28, 2022

Rigid Dressings

John T. Brinkmann, CPO

The following are responses to my question about using rigid dressings.

Thanks to all who responded.

John T. Brinkmann, CPO

John-

I do think they are beneficial as they protect the stump, control edema,

give

the client an active role during his rehab/healing period. and teach

stump

sock management and awareness of stump volume changes. I use the WU

style,

which is removable.

We haven’t been doing them much recently mostly but if I encouraged

them, the

docs would probably agree.

The only reason not to use is if client is not a candidate for a

prosthesis

or if the suture is draining.

Good Topic John!

I believe the academy will be having a discussion about Ipop in March.

We don’t do it at our VA but I think we should be doing some kind of

Ipop and

will raise these issues next March in our hospital.

I think I am more interested in removeable post op protection/prostheses

_______________

<< 1. Are you currently doing any of these procedures? 2. If not, have you been given reasons why the surgeons you work with do not use this procedure? 3. Do you believe that they are a positive step in amputee rehab? Any reasons for discouraging or encouraging its use? >>

1. Yes, Probably 500 over the past 3 years.

2. Many of our surgeons “don’t want to be bothered with it,” but call us

for

counseling prior to surgery or sometimes after.

3. Absolutely. We have had less flexion contractures. No suture lines

damaged

due to impact and earlier fittings, when the patient is compliant.

_________________________

John,

Could you email me all your replies to me. I have a resident who

will be

doing a report on why or why not rigid dressing are being used. It

appears

if you are dealing with Vascular they do not believe in them, if you are

dealing with Orthopods you do have a better chance with them.

Here at the University of Texas Health Science Center the Resident

Orthopods are being taught that a patient should wake up with a rigid

dressing with a foot and pylon and ready to go. Vascular has a different

philosphy. They want the patient completely healed to before they even

start

to consider a prosthesis for their patient.

Part of her research is going to try and to reach the Orthopods and

Vascular and General Surgeons to find out what they feel about the rigid

dressing and early walking.

_______________________________

>2. If not, have you been given reasons why the surgeons you work with

>do not use this procedure?

Mostly fear of infection in the closed environment.

>3. Do you believe that they are a positive step in amputee rehab? Any

>reasons for discouraging or encouraging its use?

>

I believe rigid dressings greatly speed the use of the definitive

prosthesis

by preventing the edema which must be reduced in the preparatory

prosthesis.

As a side benefit this control of edema also greatly reduces the

post-operative pain and discomfort experienced be the amputee.

___________________________

John,

We are trying to convert doctors and prosthetist to using plastic

removable devices (usually with foot and pylon) rather than rigid

dressings.

Although rigid dressings provide some advantages over ace wraps

(protection

of wound and control of contractures) the disadvantage of not being able

to

check the wound is a serious one that prevents many surgeons from using

them

(especially in vascular cases). In addition, the MD or CP has to have

some

skill to apply it properly and it must be taken off and redone every few

days to be effective.

In order to overcome the disadvantages of the Rigid dressing and the

plaster IPOP, Dr. Lew Schon and I developed a universally sized plastic

device called the Air-Limb (which is being sold by Aircast). Our

initial

clinical trials have included over 100 patients with very positive

results.

It is important to note, that no one method is correct for all

amputation

surgeries. Patients with poor healing potential should be treated very

conservatively until primary would healing has occurred, otherwise the

doctor, prosthetist or the plaster or plastic device may be blamed for

wound

failure.

If you would like more information on the Air-Limb or on our

research

please send me you address and I will send it to you next week.

_____________________

John, I work in the South Bay/Los Angeles area where HMOs rule. I have

never seen a rigid

dressing. I asked the boss and he has not seen any for a loong time.

They are apparently

done at some hospitals not others. Probably cost is the factor that puts

if off. From what I

have read they are a positive step toward rehab.

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