responses to new hip disarticulation patient

responses to new hip disarticulation patient

Kristin

7/12/2001

Hi List Members,
 Well we finally got a call today for a sitting prosthesis for our young
gentleman with a recent HDA. My thanks to all who responded. Here are
the responses. I hope they can help other young prosthetists like
myself. Have a great day! -Kristin Bradley, C.P.(c)

Original message: This is very third person but I'll tell you what I
know. Having
not seen an HD amputee since school I'd appreciate all comments. This
may be both a prosthetic and a seating concern.
    Earlier today an orthotist I work with was approached by an OT on
the floors. She asked him what could be done for a 30ish male recent hip

disarticulation patient who has begun to experience breakdown over his
ischial tuberosity from sitting. She explained that they tried a ROHO
cushion which has not helped. I was told he is a traumatic amputee with

significant skin grafting. He has not been admitted to our rehab setting

as of yet and therefore has not been consulted yet by prosthetics/ rehab

team but I thought I would get some opinions from the rest of the world
on this breakdown issue. Does anyone have any suggestions for seating?
What are some other concerns that may need to be addressed at this point

in his healing?

Responses:
I've used left-over pieces of Alpha liner right on the skin. The even

soft pressure and the mineral oil in the gel has a healing effect. I've

also made an Alps AK liner with a hole cut on one side as a pair of
pants.
Of course going the traditional seating route may work also, depending
on
his tolerance.
-----------------------------
You might try lining the socket with an alpha liner
in the needed spots? Just a suggestion.
-----------------------------
Is the breakdown strictly weight bearing or is it also graft related?
How long ago was the accident? You may be looking at custom seating
and/or
compression garment for graft management. Good luck.
-----------------------------
Custom seating may help. I had a case that was somewhat unusual. ~30yo

male, American Indian, chronic alcoholic, diabetic, traumatic
paraplegic.
He had developed multiple open decubiti over sacrum, ischia, and
posterior
thighs. Some brainiac doctor recommended bilateral HD's. When the
surgical sites finally healed, another story, and the patient was again
able
to sit the ulcers redeveloped with a vengeance. That is when patient
referred to see what could be done by Orthotist. All types of seating
was
tried, some less successful then others. What finally worked, when the
patient stayed moderately sober, was a bivalve TLSO with suspension
buttons
on the laterals. These buttons corresponded to suspension hook affixed
to
the seat back uprights of his wheelchair. He would develop a routine of

suspending himself on the hooks for extended periods, until his ribs
started
to become uncomfortable, then lifting himself off the hooks to sit in
his
custom molded and cushioned seat..
-----------------------------
Try pugee foam, it's the foam that they use in hospital mattresses back
home
in England, it comes in 3 grades, if you contact OttoBock Reha they
would be
able to help you as they specialize in wheelchairs and seating.
-----------------------------
Regarding the seating issue: One simple approach would be to perform
pressure mapping while your patient/client sat. This can help identify
hot areas and also help evaluate different solutions (i.e. different
cushions). A standard Roho may not be the best solution because all the

bulbs are connected by air. A Roho Quadtro allows each quarter of the
cushion to be filled to a different pressure (there are 4 valves). The
Cloud
cushion is a bulb -type of cushion where individual packets of fluid can
be
placed in each bulb. This allows some customization for pressure. In
any
case, a standard cushion my have to be built to accommodate the missing
portion of the pelvis. The chair it self may need to be modified. If
your
amputee is using a power chair, then power tilt or recline may help
relieve
pressure.
    Finally, a custom molded cushion, formed from an impression may be
the
solution.
    If he is sufficiently broken down, he may need a period where he
puts no
pressure on the sensitive area (i.e. prone bed rest), until it heals.
    Responsible rehab wheelchair vendors should have the expertise to
tackle the
problems. Roho makes a pressure mapping system (the Xsensor or
something
like that). Other mapping systems are available.
-----------------------------
We have had a few HD patients come through, although they seem to come
in rashes, 3 two years ago and one last year and only adjustments this
year. Anyway, remember back to ****'s
class and follow along with that, oh and get a second set of hands.
Wrap quite tight ...you should be able to make sitting
more comfortable by distributing the pressures (one of the clients
through was actually a hemipelvectomy who couldn't sit without his
bucket.
    You will need to keep the thickness of the socket as thin as
possible so
as to not create a hip obliquity during sitting (custom pillow with a
lift on sound side would correct if there was a problem)
    Try tossing a piece of TEC liner into the freezer to skive the edges
and
include this in the ischial seat - it should help with breakdowns - and
is difficult to retrofit!! Good luck!!
-----------------------------
Try using the waste material from the alpha liners and or any silicone
liners. Double it if you want to. I hope this helps.

Thanks again to all.