Replies to the very large TLSO problem

Replies to the very large TLSO problem

Thomas M. Wilson

1/31/2005

Thank you all for the suggestions. At the patient's request, we moved the
loops further anterior on both sides and extended the straps. This seems to
help (so far). As promised, here are the replies.

Tom Wilson, C.Ped, CO

I had a similar situation, 390# +, very loose redundant tissue, ie
hanging stomach.
I always use the chaffes on the ant shell place toward the midlife,
about 4 from center. Because of the loose tissue I attached an elastic
strap 8-10 inches wide to the inside of the posterior shell. The
elastic has a Velcro closure. Akin to riveting an abdominal binder to
the posterior shell. Patient would position the back panel while
standing, pulling the elastic around stomach to stabilize post shell,
then lie down. With her knees and hips flexed, feet flat on bed, she
then redo's the elastic binder while pulling her pendulous abdomen
proximally. Now her soft tissue is controlled and she is in good
position to clamp ant. shell. The ant shell is fastened in position and
tightened from distal to proximal, pull each sides strap at the same
time. This worked very well on a post-surgery lumbar fusion.
Hope this helps.
Morris Gallo
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It's probably a little late to recommend this, but if she's able to
apply it out of bed, there's no compelling reason for it to be bivalved
at the sides. Were it front opening, the straps would be right there.
In front. How about rivetting the sides together (if it's overlaps
sides), then cutting the front and adding a tongue?
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try a rachet system like on a ski boot

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extended chafes from the posterior extending past midline
jonathan breux CO CPed
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On all of my bivalve TLSO's I overlap the posterior over the anterior. The
loops are put on the anterior centerline (or as close to it as possible if
there is a sternal extension) and the straps are attached on the anterior
edge of the posterior section. I usually only drill one hole on the anterior
centerline, for each right and left strap, and attach both loops with the
same rivet. This arrangement makes it easier for the patient and the nursing
staff to don the TLSO.
John Hatch, CPO
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This situation is almost always a problem for very large individuals. Your
correct on solutions. Longer velcro straps with relocated loops or bagstrap
buckles with leather straps (or dacron with melted holes) provide the
simplest remedy. I like the leather due to its ease of reach by the patient
when using the heavier molding type leather. The extra length velcro straps
fall under their own weight increasing difficulty of reach by large people.
Harry Layton
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It may not be possible, but if you are able to re-fabricate the custom TLSO
as a unilateral opening body jacket it works much better. Other wise, if you
are able to attach one side in a permanent manner that will not hinder the
fit and function may help as well. Just for future thought fabricating it
with as a unilateral opening with a tongue anteriorly attached has work well
for my patients.
B.J. Stagner Jr., C.P.O.
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Forget the buckles...use a O ring 2 should do...have it long enough to
come to the front use three straps..criss cross the top two to avoid the
jacket shifting...oh Please tell me you can McGiver Good Luck