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Prosthetic services

Measuring Residual Limb

When is the residual limb ready for measurement?

How long does it take before for the residual limb is ready for measurement?

Once the initial measurements have been taken a number of test fittings are carried out.   This is vital for the comfort of the patient. I like to compare the making of a prosthesis to the making of a wedding dress. For a young future bride the making of a wedding dress is of vital importance and she wants to have it fitting absolutely perfectly.

The more fittings the dressmaker is prepared to do for her, the happier she will be as she wants the outcome to be perfect. If the dressmaker’s worth her salt and has pride in her work she will be happy to do the extra fittings even though they are not in the initial cost.

We will do as much as it takes to make sure that the outcome of the prosthesis will give the patient comfort, mobility and confidence. If the patient is a trans femoral (above knee amputee)the process of measuring and fitting for the first walking prosthesis takes between three and five days.

If the amputee is a trans tibial (below the knee amputee) the first walking prosthesis can be anything from one hour to 2 days once both the patient and the prosthetist are happy with the fit. When the final prosthesis is made the time frame should not be longer than three weeks before the finished prosthesis is fitted.

During this process the amputee goes for an extensive exercise program which is carried out by an experienced physiotherapy team.

The Rehabilitation exercise program is optional and it depends on the economic situation of the patient usually the medical aid will pay for this service as they have already invested money in the prosthesis and they would like the amputee to make full use of the prosthesis. Even though the exercise sessions are long and hard my patients report to me that they are a lot of fun. Actually I find them fun because I join in some times especially the dance class.

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Prosthetic services

Does your prosthesis hurt? Are you walking with difficulty?

While various levels of amputations are carried out, by far, the most common involve:

  • Below knee (trans tibial)
  • Above knee (trans femoral)

No matter the amputation level, there is a great deal your dedicated prosthetist can do to diagnose and employ the right measures in order to alleviate any painful conditions associated with prosthetic use.

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Prosthetic services

From amputation to prosthesis in three weeks

From post-op to crutches within five days and walking comfortably with a prosthesis in as little as three weeks! The idea of walking with crutches within five days post-op and being able to walk with a prosthesis in as little as three weeks after undergoing an amputation sounds like science fiction – but it is not. It is just up to clever engineering on behalf of Roger Wolfson and a desire to get walking again.

Yet, it is even more surprising to learn that the technique used in creating a prosthesis designed to do just that has been around for many years.

Why surgeons should regularly use the services of a prosthetist when performing an amputation

Should a surgeon perform the amputation procedure in consultation with a prosthetist that is familiar with the Immediate Post-Operative Prosthesis (IPOP) technique, the results can be extremely beneficial to the well-being of the patient, and result in considerable cost savings to both patients and funding sponsors alike.

A scientific paper pertaining to this very topic was presented at an Orthopaedic Surgeons Congress that took place in South Africa recently. However, despite the fact that the Chairman of the Congress raised the burning question as to why, in fact, surgeons don’t regularly consult with a prosthetist around the surgical procedure, the fact still remains that as things currently stand, the number of surgeons that use the services of a prosthetist nevertheless remains fewer than desired.

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Prosthetic services

Immediate Post-Operative Prosthesis (Ipop)

Introduction to Immediate Post-Operative Prosthesis (IPOP)

Amputation is a critical salvage procedure when it comes to septic and tumour patients. Due to the process of ‘coning’ of the residual limb, which is undertaken in order to facilitate the application of a primary prosthesis, the rehabilitation process post-surgery is often delayed; which can be extremely costly both to the patient as well as the health system.

It is also during this time that muscle strength, tone, general fitness and co-ordination may be reduced, which further retards the rehabilitative process.

The Immediate Post-Operative Prosthesis (IPOP) technique attempts to address these problems with the application of a rigid cast immediately post-surgery while the patient is still in the operating theatre, and the attachment of a temporary prosthesis soon thereafter. This ensures that the healing of the wound and the rehabilitation process occur in tandem, thereby diminishing the effects of muscle wasting and enabling more rapid mobilisation with the primary prosthesis.

The Immediate Post-Operative Prosthesis (IPOP) technique dates back to 1893

  • The Immediate Post-Operative Prosthesis (IPOP) technique is not new. In fact, the first reports of the use of the IPOP technique date back to 1893, when a German surgeon, von Bier, reported accelerated rehabilitation with the use of a rigid plaster cast to which a wooden peg leg was attached immediately following surgery.

  • In 1918, a surgeon by the name of Wilson also reported excellent results having used the IPOP technique on injured soldiers during World War I.

  • In 1957, surgeons Berlemont and Wiess reported the successful use of a thigh cast attached immediately post-surgery to below knee prostheses following trans tibial amputations.

  • In South Africa, the IPOP technique has been used for several decades. However, such usage has not been well-documented, and this appears to be the reason behind the fact that the technique has been under-utilised in recent years.

  • Recently, a prospective study of septic and tumour amputees was undertaken at the Johannesburg Hospital in order to evaluate the advantages and disadvantages of the IPOP technique.

The Immediate Post-Operative Prosthesis (IPOP) technique: six-step process

What follows is a brief six-step process outlining the technique involved in creating an ‘Immediate Post-Operative Prosthesis’ otherwise known as ‘IPOP’:

  1. The surgeon first performs the surgical procedure and isolates the sterile wound.

  2. Orthopedic wool is then wrapped around the residual limb (stump), following which, a crêpe bandage as well as Elastoplast bandages are also applied.

  3. Further padding and a stockinette is applied at this stage.

  4. A layer of plaster bandage is then applied to ensure a smooth rigid cast with no sharp edges.

  5. Fiberglass bandages are then applied.

  6. A peg leg should be attached within two days post-surgery which enables the patient to walk within two to five days thereafter.

Benefits of the Immediate Post-Operative (IPOP) technique

  • The IPOP technique aids in the prevention of swelling that would otherwise need to be reduced using coning bandages which is an extremely time consuming process, and often can take up to six months.

  • The rigid cast is applied in a sterile theatre which significantly reduces the chances of infection.

  • Results in increased psychological well-being post-surgery, in that the patient can mobilize almost immediately thereafter.

Should the patient be contracted with Roger Wolfson and Associates, an Immediate Post-Operative Prosthesis (IPOP) is offered free of charge. However, costs will be incurred should the patient already be in consultation with another prosthetist.

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