RESPONSES: looking for articles
zach harvey
Description
Collection
Title:
RESPONSES: looking for articles
Creator:
zach harvey
Date:
3/24/2004
Text:
Thanks to all who responded. My original post asked for articles
pertaining to justification for temporary prostheses vs. going
strait to a definitive. In my particular situation, the doctor
working for the insurance company has denied coverage of a temporary.
I ended up providing a definitive and will most likely change out
socket later on, and/ or different components if the K-level changes.
Responses are as follows... Zach Harvey, CPO
RESPONSES:
just make up a laminated socket and pylon (say the Endolite system)This will satisfy the doc and also get patient well on the way to rehab andsuccessful ambulation. With this system I find that I can pad up the socketas much as I need to protect the sutures and I just follow the stump sizedown with successive sockets. I wrote an article to this effect for O&PWorld early last year.This effectively eliminates the need for the old 'interim' notion. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Send me your fax number I'll fax you the Maricopa study. I think it willhelp.~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
In July such a document will exist. The results of the Academy's PostOperative consensus conference on Major lower limb amputations will bepublished in JPO. The highlights as it pertains to your questions are:1) There is no appropriate literature to support early fitting of a pylonhowever, the consensus was that early mobility, protection of the limb, fallprevention and edema control are essential.2) Fitting of a definitive prosthesis before limb stabilization and before 6months of full time temp prosthesis use is inappropriate, as the limbcontinues to shrink and change, necessitating many adjustments and socketchanges.3) The presence of sutures or wounds does not preclude weight bearing.4) The post-operative course is a period of 12-18 months that simply cannotbe rushed. The process of edema control and limb volume stabilization willnot be something that we can control and therefore a regimen that keeps thisperiod of time in mind will do much better than one that is rushe!
d.Again,
the literature in this area is terrible and even the studies that weperceived as gold standard, such as those from Burgess on IPOP, are not wellcontrolled and took many liberties with the data so to invalidate theirrecommendations. I realize that this may or may not help your current cause,but clearly like many areas of O and P, we just don't have the literature toback up some of the things we do on a regular basis. Look for thesupplement with July's JPO as there is a lot of information that should helpyou in the future, and I will be happy to answer any questions you may havein the mean time.. good luck.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1) Postoperative dressing and management strategies for transtibialamputations: A critical review Douglas G. Smith, MD; Lynne V. McFarland, PhD, MS; Bruce J. Sangeorzan, MD;Gayle E. Reiber, PhD, MPH; Joseph M. Czerniecki, MD Department of Orthopedics and Sports Medicine, University of Washington,Seattle, WA; Prosthetic Research Study, Seattle, WA; Amputee Coalition ofAmerica, Knoxville, TN; Department of Health Services, University ofWashington, Seattle, WA; Department of Veterans Affairs (VA) HealthServices Research and Development, Seattle, WA; VA Center of Excellence forLimb Loss Prevention and Prosthetics Engineering and VA RehabilitationResearch and Development, Puget Sound Health Care System, Seattle, WA;Department of Rehabilitation Medicine, University of Washington, Seattle,WA Abstract ?Postamputation management is an important determinant ofrecovery from amputation. However, consensus on the most effectivepostoperative management strategies for individuals undergoing
transtibialamputation (TTA) is lacking. Dressings can include simple soft gauzedressings, thigh-high rigid cast dressings, shorter removable rigiddressings, and prefabricated pneumatic dressings. Postoperative prostheticattachments can be added to all but simple soft dressings. These dressingsaddress the need to cleanly cover a fresh surgical wound, but not allpostoperative dressings are designed to facilitate the strategic goals ofpreventing knee contractures, reducing edema, protecting from externaltrauma, or facilitating early weight bearing. The type of dressing andmanagement strategy often overlap and are certainly interrelated. Currentprotocols and decisions are based on local practice, skill, and intuition.The current available literature is challenging, and difficulties includevariations in healing potential, in comorbidity, in surgical-levelselection, in techniques and skill, in experience with postoperativestrategies, and with poorly defined outcome criteria. This!
paper
reviewsthe published literature and compares measures of safety, efficacy, andclinical outcomes of the various techniques. Analysis of 10 controlledstudies supported only 4 of the 14 claims cited in uncontrolled,descriptive studies. The literature supports that rigid plaster cast dressings result insignificantly accelerated rehabilitation times and significantly less edemacompared to soft gauze dressings, and prefabricated pneumatic prostheseswere found to have significantly fewer postsurgical complications andrequired fewer higher-level revisions compared to soft gauze dressings. Nostudies directly compared pneumatic prostheses with rigid dressings, and noreports compared all types of dressings within one study. In conclusion,the literature and evidence to date is primarily antidotal and insufficientto support many of the claims. Future randomized trials on TTA dressing andmanagement strategies are clearly needed to collect the evidence needed tobest guide clinicians with !
the
decision. 2)Benefits of Early Prosthetic Management of Transtibial Amputees: AProspective Clinical Study of a Prefabricated Prosthesis TLew C. Schon, M.D; Kelly W. Short, PT; Olga Soupiou, RN.; Kenneth Noll,CO; John Rheinstein, CP To evaluate the use of an immediate postoperative prosthesis (IPOP) fortranstibial amputees, we compared patient outcomes from a prospectiveclinical study of 19 patients managed with an IPOP with those of aretrospective review of a matched historic control group of 23 patientsmanaged with standard soft dressings. Data were analyzed with the Student'st-test, and significance was set at P=O.05. The IPOP patients had nosurgical revisions, whereas the patients with standard soft dressings had11. This was a significant difference. IPOP patients also had significantlyfewer postoperative complications and shorter times to custom prosthesisthan did controls.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
I have encounter that same dilema. I always wait till all suteres are
heal.
You could do a permanent for psychological reasons and six months
later or
so you can do a change of socket.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Contact Bob Brown at Flotech. He has some good sources for you.
Do you Yahoo!?
Yahoo! Finance Tax Center - File online. File on time.
pertaining to justification for temporary prostheses vs. going
strait to a definitive. In my particular situation, the doctor
working for the insurance company has denied coverage of a temporary.
I ended up providing a definitive and will most likely change out
socket later on, and/ or different components if the K-level changes.
Responses are as follows... Zach Harvey, CPO
RESPONSES:
just make up a laminated socket and pylon (say the Endolite system)This will satisfy the doc and also get patient well on the way to rehab andsuccessful ambulation. With this system I find that I can pad up the socketas much as I need to protect the sutures and I just follow the stump sizedown with successive sockets. I wrote an article to this effect for O&PWorld early last year.This effectively eliminates the need for the old 'interim' notion. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Send me your fax number I'll fax you the Maricopa study. I think it willhelp.~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
In July such a document will exist. The results of the Academy's PostOperative consensus conference on Major lower limb amputations will bepublished in JPO. The highlights as it pertains to your questions are:1) There is no appropriate literature to support early fitting of a pylonhowever, the consensus was that early mobility, protection of the limb, fallprevention and edema control are essential.2) Fitting of a definitive prosthesis before limb stabilization and before 6months of full time temp prosthesis use is inappropriate, as the limbcontinues to shrink and change, necessitating many adjustments and socketchanges.3) The presence of sutures or wounds does not preclude weight bearing.4) The post-operative course is a period of 12-18 months that simply cannotbe rushed. The process of edema control and limb volume stabilization willnot be something that we can control and therefore a regimen that keeps thisperiod of time in mind will do much better than one that is rushe!
d.Again,
the literature in this area is terrible and even the studies that weperceived as gold standard, such as those from Burgess on IPOP, are not wellcontrolled and took many liberties with the data so to invalidate theirrecommendations. I realize that this may or may not help your current cause,but clearly like many areas of O and P, we just don't have the literature toback up some of the things we do on a regular basis. Look for thesupplement with July's JPO as there is a lot of information that should helpyou in the future, and I will be happy to answer any questions you may havein the mean time.. good luck.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1) Postoperative dressing and management strategies for transtibialamputations: A critical review Douglas G. Smith, MD; Lynne V. McFarland, PhD, MS; Bruce J. Sangeorzan, MD;Gayle E. Reiber, PhD, MPH; Joseph M. Czerniecki, MD Department of Orthopedics and Sports Medicine, University of Washington,Seattle, WA; Prosthetic Research Study, Seattle, WA; Amputee Coalition ofAmerica, Knoxville, TN; Department of Health Services, University ofWashington, Seattle, WA; Department of Veterans Affairs (VA) HealthServices Research and Development, Seattle, WA; VA Center of Excellence forLimb Loss Prevention and Prosthetics Engineering and VA RehabilitationResearch and Development, Puget Sound Health Care System, Seattle, WA;Department of Rehabilitation Medicine, University of Washington, Seattle,WA Abstract ?Postamputation management is an important determinant ofrecovery from amputation. However, consensus on the most effectivepostoperative management strategies for individuals undergoing
transtibialamputation (TTA) is lacking. Dressings can include simple soft gauzedressings, thigh-high rigid cast dressings, shorter removable rigiddressings, and prefabricated pneumatic dressings. Postoperative prostheticattachments can be added to all but simple soft dressings. These dressingsaddress the need to cleanly cover a fresh surgical wound, but not allpostoperative dressings are designed to facilitate the strategic goals ofpreventing knee contractures, reducing edema, protecting from externaltrauma, or facilitating early weight bearing. The type of dressing andmanagement strategy often overlap and are certainly interrelated. Currentprotocols and decisions are based on local practice, skill, and intuition.The current available literature is challenging, and difficulties includevariations in healing potential, in comorbidity, in surgical-levelselection, in techniques and skill, in experience with postoperativestrategies, and with poorly defined outcome criteria. This!
paper
reviewsthe published literature and compares measures of safety, efficacy, andclinical outcomes of the various techniques. Analysis of 10 controlledstudies supported only 4 of the 14 claims cited in uncontrolled,descriptive studies. The literature supports that rigid plaster cast dressings result insignificantly accelerated rehabilitation times and significantly less edemacompared to soft gauze dressings, and prefabricated pneumatic prostheseswere found to have significantly fewer postsurgical complications andrequired fewer higher-level revisions compared to soft gauze dressings. Nostudies directly compared pneumatic prostheses with rigid dressings, and noreports compared all types of dressings within one study. In conclusion,the literature and evidence to date is primarily antidotal and insufficientto support many of the claims. Future randomized trials on TTA dressing andmanagement strategies are clearly needed to collect the evidence needed tobest guide clinicians with !
the
decision. 2)Benefits of Early Prosthetic Management of Transtibial Amputees: AProspective Clinical Study of a Prefabricated Prosthesis TLew C. Schon, M.D; Kelly W. Short, PT; Olga Soupiou, RN.; Kenneth Noll,CO; John Rheinstein, CP To evaluate the use of an immediate postoperative prosthesis (IPOP) fortranstibial amputees, we compared patient outcomes from a prospectiveclinical study of 19 patients managed with an IPOP with those of aretrospective review of a matched historic control group of 23 patientsmanaged with standard soft dressings. Data were analyzed with the Student'st-test, and significance was set at P=O.05. The IPOP patients had nosurgical revisions, whereas the patients with standard soft dressings had11. This was a significant difference. IPOP patients also had significantlyfewer postoperative complications and shorter times to custom prosthesisthan did controls.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
I have encounter that same dilema. I always wait till all suteres are
heal.
You could do a permanent for psychological reasons and six months
later or
so you can do a change of socket.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Contact Bob Brown at Flotech. He has some good sources for you.
Do you Yahoo!?
Yahoo! Finance Tax Center - File online. File on time.
Citation
zach harvey, “RESPONSES: looking for articles,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 6, 2024, https://library.drfop.org/items/show/222796.
