URGENT request for Scleroderma patient

URGENT request for Scleroderma patient

Have recently had a request to evaluate a scleroderma patient that is pending
transtibial amputation. Need input.

Saw same patient 3months ago. At that time she was ambulatory, in good
spirits, independent and highly motivated. 48yo with 2 children. Dx'd with
systemic Scleroderma.

Received PMR phone request late today(6:30pm on 03/27)for pre-op BK
amputation level selection and rehab planning consult for POTENTIAL
prosthetic function. PMR suggests that Rehab and functional potential are
poor based upon 1)UE limitations,2)prior history of skin tolerance due to
atherosclerosis and 3) sound side WB tolerance limitations due to existing
ulcerations.

I have not yet been able to review chart, patient or recent history other
than phone info received. However, this patient is currently in isolation.
She has multiple atherosclerotic lesions on transmet amputation on Lt. with
mutliple Rt toe and metatarsal amputations. Bilat upper extremity digital
amputations with existing sclerotic lesions on some remaining digits. Lt LE
Transmet was done within past six weeks and is currently at risk for
transtibial amputation.

My experience with scleroderma is limited. Basic understanding is that skin
tolerance for pressure and shear are poor. (Am using burns as a reference
with diabetes superimposed). Her ROM is limited in all planes to that of
minimal functional necessity. ie Knee flexion to 75 degrees, hip flexion to
80 degrees, etc.

My initial thoughts were that Px function would be limited to
transfers.(unknown if she has had ischial breakdown)

In the event that a TT amputation is required, what suggestions does the
listserve have for:
1-edema control
2-potential for px function(anticipate goals set very low, transfer use
only?)
3-long term?

Any help, input is appreciated. Will post summary (eventually) but need input
within 48 hours(before12:00 noon PST on friday 03/29/02).

Thanks in advance.
Ralph W Nobbe CPO
(805) 687-7508 tel