RRD & IPOP's
Liz Bush
Description
Collection
Title:
RRD & IPOP's
Creator:
Liz Bush
Date:
5/9/2007
Text:
Thanks to all who responded - I had many requests for posting the
responses, so:
Liz Bush CO
American Limb & Orthopedic Co.
* Textbook chapter 2 Post-op Care:
<URL Redacted>
< <URL Redacted>>
Website: <URL Redacted>
-33C0-4E0C-8592-9B507DDF400B&rnd=230758962
Research:
1) Schon LC, Short KW, Soupiou O, Noll K, Rheinstein J. Benefits of
early prosthetic management of transtibial amputees: a prospective
clinical study of a prefabricated prosthesis. Foot Ankle Int
2002;23:509-14 .
2) AAOPs State of the Science Consensus Conference on Post-op Management
in which Dr. Schon participated. http://www.oandp.org/jpo/ssc.asp click
#2
3) Schon LC, Badekas A, Boucher HR. The Air-Limb - A Universal Immediate
Or Early Postoperative Prosthesis: A biomechanical assessment.
* Strong Memorial Hospital/ University of Rochester in New York
state and almost every amputee got either a rigid dressing which was
changed weekly, or a bivalved removable rigid dressing or a FloTech
device merely for protection if they were concerned about healing
capability of the wound.
* Several of my customers that are using IPOP's and I will pass
this along to them to see if they will respond to you.
Fillauer has a low cost IPOP system that does not require rigid casting.
The fact you don't have to do the cast has made it easier to get some
hospitals to try IPOP's.
Our POP'PY has an inner protector ($114) with velcro straps and a very
soft EVA foam distal pad. The socket/pylon portion ($280) is great for
getting patients to stand and weight bear in therapy and is reusable.
Some practitioners will put the protector portion on the new amputee in
the hospital for of the residual limb and loan the socket/pylon
portion to the P.T. department.
* We've been using the removable rigid dressing here at Duke Univ.
Med. Center for about a year now. My boss, David R. Sickles, CPO and
CPed, is responsible for putting this into place and the doctors are
quite pleased with the results.
* I am hoping that you would post reply's if possible as this is
certainly an area of great debate. Our facility uses soft dressings and
tensors and will use stump protectors which are molded fibreglass
splints that will protect against occassional bumps and scrapes.
Certainly the literature supports the use of removable rigid dressings
(Journal of Rehabilitation Research and Development Vol.40, No. 3,
May/June 2003 pages 213-224 Postoperative dressing and management
strategies for transtibial amputations: A critical review) in that they
result in significantly accelerated rehab times and significantly less
edema compared to soft gauze dressings. This review was not at all
supportive of IPOPs.
* Like all major medical centers our local hospital uses check
the box-type Pre-Op and Post-OP Order Sets for most major proceedures
(Spine fususions, total arthroplasty, etc.) including Post-Op
amputation. An old & wise vascular surgeon got the ball rolling 5-6
years ago with these and they were used routinely. He has since retired
and they have fallen out of favor. Order sets are necessary/useful for
many reasons (continuity, liability, efficiency, etc.) and i would
suggest you approach it from this prospective. Have hospital create
Post-Op Amputation Order Sets for inclusion in their internal intranet
system. Order sets can include options such as Removeable Rigid
Dressing or Limb Shrinker or Soft Dressing with Ace Wrap, they may
also indicate First Dressing Change Date, etc. If you give
docs/hospital options they are more likely to incorporate the order
sets. After that its up to you to grass-roots educate & support their
use and your prefered Option. Please post all responses. Thanks.
* Here's what we do. The orthopaedic surgeon or physiatrist calls
me about 7 days post-op and asks me to take a cast. Depending on edema,
I will have applied a stump shrinker a few days before using a clean
paint can or similar donning device. The cast is taken over the limb
which usually still has an absorbent dressing on the suture line. I
manufacture a thermoplastic definitive monolithic socket often within a
24-48 hr. turnaround time. The socket is fit around 10 days post-op.
Depending on the patient's readiness for wt. bearing I fit the socket
with distal components or if the wound is still fragile the socket is
fit alone. Distal components can be bolted on when the patient's wound
is ready. Suspension is via airtight sealing sleeve (ALPS). This has
shown to be a very quick way to mobilize a new amp with a custom socket
which will have fit lasting anywhere from 1-4 months. After this point
we go to the first definitve socket which may last for 6-12 months. The
modified polypro sockets are quick, economical and clean to fabricate,
hygienic to maintain and are as light and more durable than composite
sockets.
* We have been using rigid removable dressings since 2000 and have
had excellent success. We use Seattle's casting sock which is applied
in theatre by the theatre staff who we have trained to apply them. A
new one is made at 10 days post op and then as necessary. The results
have been excellent, good post surgical oedema control, stump
protection, only one patient has been returned to theatre for resuturing
in the 6 years we've been using them. Patient is more comfortable and
we have found improved wound healing compared with pre RRD's days.
Residual limb shape is better and earlier casting can occur.
* I am a prosthetist in a 900+ bed, level 1 trauma center,
teaching hospital....listed as one of
Best Hospitals in America
We sometimes provide half a dozen RRD's a day, along with IPOP's....In
the OR, Recovery or bedside.
It is an efficient, cost effective system for the hospital, providing
first-rate treatment for the patient. The protocol is in place, well
understood by the rehab team......excellent outcomes.
To be effective, you should have an adequate number of practitioners
readily available at all times for quality care and follow-up. Hope this
helps
* Our local surgeons use Flo-Techs regularly. The hospital covers
the cost using the L-Code for rigid dressings. Socks, shrinkers, etc are
extra (don't get caught violating the kick-back laws by providing the
accessories for free!) Plaster dressings are a whole lot more hassle
for questionable added benefit, in my opinion. A removable plastic
system is the best option in my experience
* swedish hospital seattle; harborview medical center, seattle;
valley medical center, kent wa. pretty much, most of the northwest is
in due to dr-s burgess and doug smith works.
responses, so:
Liz Bush CO
American Limb & Orthopedic Co.
* Textbook chapter 2 Post-op Care:
<URL Redacted>
< <URL Redacted>>
Website: <URL Redacted>
-33C0-4E0C-8592-9B507DDF400B&rnd=230758962
Research:
1) Schon LC, Short KW, Soupiou O, Noll K, Rheinstein J. Benefits of
early prosthetic management of transtibial amputees: a prospective
clinical study of a prefabricated prosthesis. Foot Ankle Int
2002;23:509-14 .
2) AAOPs State of the Science Consensus Conference on Post-op Management
in which Dr. Schon participated. http://www.oandp.org/jpo/ssc.asp click
#2
3) Schon LC, Badekas A, Boucher HR. The Air-Limb - A Universal Immediate
Or Early Postoperative Prosthesis: A biomechanical assessment.
* Strong Memorial Hospital/ University of Rochester in New York
state and almost every amputee got either a rigid dressing which was
changed weekly, or a bivalved removable rigid dressing or a FloTech
device merely for protection if they were concerned about healing
capability of the wound.
* Several of my customers that are using IPOP's and I will pass
this along to them to see if they will respond to you.
Fillauer has a low cost IPOP system that does not require rigid casting.
The fact you don't have to do the cast has made it easier to get some
hospitals to try IPOP's.
Our POP'PY has an inner protector ($114) with velcro straps and a very
soft EVA foam distal pad. The socket/pylon portion ($280) is great for
getting patients to stand and weight bear in therapy and is reusable.
Some practitioners will put the protector portion on the new amputee in
the hospital for of the residual limb and loan the socket/pylon
portion to the P.T. department.
* We've been using the removable rigid dressing here at Duke Univ.
Med. Center for about a year now. My boss, David R. Sickles, CPO and
CPed, is responsible for putting this into place and the doctors are
quite pleased with the results.
* I am hoping that you would post reply's if possible as this is
certainly an area of great debate. Our facility uses soft dressings and
tensors and will use stump protectors which are molded fibreglass
splints that will protect against occassional bumps and scrapes.
Certainly the literature supports the use of removable rigid dressings
(Journal of Rehabilitation Research and Development Vol.40, No. 3,
May/June 2003 pages 213-224 Postoperative dressing and management
strategies for transtibial amputations: A critical review) in that they
result in significantly accelerated rehab times and significantly less
edema compared to soft gauze dressings. This review was not at all
supportive of IPOPs.
* Like all major medical centers our local hospital uses check
the box-type Pre-Op and Post-OP Order Sets for most major proceedures
(Spine fususions, total arthroplasty, etc.) including Post-Op
amputation. An old & wise vascular surgeon got the ball rolling 5-6
years ago with these and they were used routinely. He has since retired
and they have fallen out of favor. Order sets are necessary/useful for
many reasons (continuity, liability, efficiency, etc.) and i would
suggest you approach it from this prospective. Have hospital create
Post-Op Amputation Order Sets for inclusion in their internal intranet
system. Order sets can include options such as Removeable Rigid
Dressing or Limb Shrinker or Soft Dressing with Ace Wrap, they may
also indicate First Dressing Change Date, etc. If you give
docs/hospital options they are more likely to incorporate the order
sets. After that its up to you to grass-roots educate & support their
use and your prefered Option. Please post all responses. Thanks.
* Here's what we do. The orthopaedic surgeon or physiatrist calls
me about 7 days post-op and asks me to take a cast. Depending on edema,
I will have applied a stump shrinker a few days before using a clean
paint can or similar donning device. The cast is taken over the limb
which usually still has an absorbent dressing on the suture line. I
manufacture a thermoplastic definitive monolithic socket often within a
24-48 hr. turnaround time. The socket is fit around 10 days post-op.
Depending on the patient's readiness for wt. bearing I fit the socket
with distal components or if the wound is still fragile the socket is
fit alone. Distal components can be bolted on when the patient's wound
is ready. Suspension is via airtight sealing sleeve (ALPS). This has
shown to be a very quick way to mobilize a new amp with a custom socket
which will have fit lasting anywhere from 1-4 months. After this point
we go to the first definitve socket which may last for 6-12 months. The
modified polypro sockets are quick, economical and clean to fabricate,
hygienic to maintain and are as light and more durable than composite
sockets.
* We have been using rigid removable dressings since 2000 and have
had excellent success. We use Seattle's casting sock which is applied
in theatre by the theatre staff who we have trained to apply them. A
new one is made at 10 days post op and then as necessary. The results
have been excellent, good post surgical oedema control, stump
protection, only one patient has been returned to theatre for resuturing
in the 6 years we've been using them. Patient is more comfortable and
we have found improved wound healing compared with pre RRD's days.
Residual limb shape is better and earlier casting can occur.
* I am a prosthetist in a 900+ bed, level 1 trauma center,
teaching hospital....listed as one of
Best Hospitals in America
We sometimes provide half a dozen RRD's a day, along with IPOP's....In
the OR, Recovery or bedside.
It is an efficient, cost effective system for the hospital, providing
first-rate treatment for the patient. The protocol is in place, well
understood by the rehab team......excellent outcomes.
To be effective, you should have an adequate number of practitioners
readily available at all times for quality care and follow-up. Hope this
helps
* Our local surgeons use Flo-Techs regularly. The hospital covers
the cost using the L-Code for rigid dressings. Socks, shrinkers, etc are
extra (don't get caught violating the kick-back laws by providing the
accessories for free!) Plaster dressings are a whole lot more hassle
for questionable added benefit, in my opinion. A removable plastic
system is the best option in my experience
* swedish hospital seattle; harborview medical center, seattle;
valley medical center, kent wa. pretty much, most of the northwest is
in due to dr-s burgess and doug smith works.
Citation
Liz Bush, “RRD & IPOP's,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/228262.
