Prosthetic Post surgical considerations

what are the types of prosthetist intervention?

• closed amputation

• open amputation

• myodesis

• myoplasty

what is closed amputation?

• elective procedure

• skin is closed after amputation

what is open amputation?

• wound is left open over amputation stump and is not closed

• done as an emergency procedure in the case of life threatening infection (severe infection, severe crush injury)

what is myodesis

muscle is sutured to the bone

what is myoplasty ?

muscle is sutured to the opposite muscle group under appropriate tension

Types of post surgical residual limbs

Things to observe on new RL
Dog Ears
Sutures
Tissue density/ skin condition
Color
Drainage/ Discharge
Odor

Transfemoral TF

Infection/ Necrotic tissues

complications

TT with Skin graft

What is the impact from these conditions?

Healing rate , Strength/endurances, Safety

What is to be anticipated?

Patient participation, Motivation Limitations

What do we do?

Encourage, Educate, Protect

• Educate patient and family- what to expect, have them involved in the care plan

• Manage pain- medications, mirror therapy, desensitization methods, breathing time

• Stress Safety- awareness of phantom sensation ,fall risk, use of assistive devices, caution when mobile

• Facilitate Healing- wound care, AROM to tolerance, Limb protection , residual limb shaping/edema control

• Promote return of independence-
  cardiovascular gain, endurance, mobility, ambulation

• Prepare for D/C & prosthetic care- RL manipulation/desensitization/ prevent contractures

objectives

• soft - ace bandage

• rigid - cast

• semi rigid = “crash helmet”

types of dressings

removable semi rigid dressings

Rooke Dressing

IPOP- Immediat4 Postop Prosthesis

Goal of healed mature Residual limb

• Cause- trauma vs vascular vs cancer

• Level- higher amputation equates to greater function lost, increased energy requirement

• Patient age- endurance, strength, & balance influenced by the patient’s age

• History- what was the person able to do before? What is their home like?

Impact on recovery rate

Bilateral amputation

Hip Disarticulation/ hemipelvectomy

• Similar to the implant technology of joint replacements and dental replacements.

• Currently, FDA Approved for TF only.

• Started in England and Australia

• Now offered in specialized clinics in the USA (NYU Langome)

• Candidates are currently TF amputees due to cancer or Trauma

• Patients with failed or potential problems with conventional socket fittings/suspension.

• First stage implant anchor insertion with 6 months recovery time NWB

• Second procedure for the attachment implant with slow weight bearing for 6 months before full weight bearing with prosthesis

• Complications can be - Risk of failure, infection and limited K3 activity( no high impact)

• Benefit of some proprioception, increased wear time tolerances, and increased function

Osseointegration (2 stage OPRA)

Unusual cases

• The Ertl procedure emphasizes bony and soft tissue reconstruction to create a stable, dynamic limb.

• Tibiofibular Bone Bridge:

• Myoplasty:

• Neurolysis:

• Improved End-Bearing: .

• Improved Prosthetic Fitting:

Ertl Procedure

what is Tibiofibular Bone Bridge:

It involves creating a bone bridge (synostosis) between the cut ends of the tibia and fibula, aiming for a stable, broad tibiofibular articulation.

what is Myoplasty

A myoplasty (muscle attachment to bone) is performed to cover the distal stump and improve muscle function.

what is neurolysis

Nerves are identified, placed on stretch, and transected as proximal as possible to eliminate neuroma formation.

what is improved end-bearing

The goal is to allow patients to bear more weight comfortably on their residual limb, potentially improving gait and function

what is improved prosthetic fitting

The stable, reconstructed limb is designed to facilitate easier and more functional prosthetic fittings.

This surgical procedure was pioneered in 2002 by Gregory A.
Dumanian, MD, a plastic surgeon at Northwestern Medicine,
and Todd Kuiken, MD, PhD, a physiatrist and professor at the
Northwestern University McCormick School of Engineering. It was
originally developed to help people who had limbs amputated
control their upper limb prosthetics. In their research, Dr.
Dumanian and Dr. Kuiken observed an unexpected benefit of TMS
surgery: reduced phantom limb pain and neuroma.

Targeted muscle reinnervation- TMR