Immediate Post Operative Prosthesis (Replies)

Immediate Post Operative Prosthesis (Replies)

Kevin S. Garrison C.P., L.P. / Author

6/25/2007

Dear OANDP.COM List,
Her are the replies for those of you that requested to see them regarding the IPOP procedure.
Again than thank you for your time, those of you that replied, I appreciated it very much!
Respectfully,
Kevin S. Garrison C.P., L.P./Author

I was an immediate post op back in 1975. I was 20, strong, traumatic
accident (I pulled it off under a train car), 185 lbs at the time of the
accident but 120 17 days later when I left the hospital. I attribute my
walking success to never forgetting. Any advice I can give from a
patients point of view just ask.

I have found the following...
1-Yes, it is still going on... however, hospitals are looking at more cost effective ways of managing patients. We have one hospital who does not use them, but waits for the patients stitches to be removed, then fit with a shrinker. Another hospital is using a full IPOP, but simply because of a particular vascular surgeon's request. They are looking to do away with IPOP's and move to shrinkers only.
2-Vascular Surgeon
3-Any age group who can tolerate weight bearing, and is strong enough to stand with assistance
4-I have not seen a limit on weight, but have not had anyone over 220 lbs
5-I believe yes... to get a patient into a prosthesis as early as possible, then do a socket change once needed.

During my prosthetics residency at the Seattle VA- 2005-2006- I personally fit plaster Immediate Postoperative Casts (IPOCS) every week, and my supervisor did a few with the pylon (IPOPS- Immediate Postoperative Prostheses). The practice is also done at various other local hospitals in the Seattle area. I believe that most of the surgeries were done by orthopedic surgeons, and a smaller number by vascular surgeons. The VA has mostly a geriatric patient base, but one IPOP was fit to a young man when I was there. The folks we made IPOCS and IPOPS for were everywhere between slender and obese. I'm not sure if early fittings are more common than immediate fittings. Many of the patients I dealt with went into IPOCs and flotecs, had delayed healing, went through amputee clinic, and then received an interim prosthesis, then eventually a definitive one.
 
We havn't done an IPOP in probably 10 years.

I still do provide IPS fittings while the patient is still on the table and has on the tourniquet. The majority of these are provided for Orthopedic, Vascular, Plastic and general surgeons. I have found that if the patient has good blood supply to the remaining tissues this cuts the time from onset to permanent prosthesis by upwards of 33%. I just fitted one Wed. to a 73yo female under 170 lbs. I wish that these were more common than they used to be, immediate fittings allow the edema to enter into the equation. The reality is that they are much more effective than waiting for the edema to take control.