Wrapping elastic bandage ace wrap for above the knee amputation. The decision as to when to amputate or when to attempt limb salvage remains controversial. When the patient discharges from your care, be sure to educate them on the importance of continuing this. May 03, 2014 how to apply ace wrap for a patient with a below knee amputation. Start 4 inch ace wrap by anchoring with one hand in the same start position and progress roll diagonally down across. Even after the surgical wound has healed, your residual limb can still be swollen.
Chapter 4 rehabilitation of the injured combatant vol 1. Phantom sensation phantom pain residual limb pain touch pressure cold wetness itching formication fatigue general pain telescoping limb phantom movement dull aching. Lengthening belowknee amputation to enhance prosthetic wear. Wrapping the residual limb with a compression bandage 2 and page 3 or a silicone liner page 4. The patient reported a wrapping sensation in her socket. Once a stump shrinker has been provided, you should keep it on at all times. General notes apply gentle tension to the wrap while applying, but avoid. When seated, always keep your residual limb supported and the knee straight. This 3 minute video instructs the viewer how to ace wrap the residual limb of someone with a bka tta. The main postsurgical complications are cardiovascular, residual limb pain and phantom sensation, oedema. If the amputation is above the knee, keep your residual limb close to the intact leg. While you are a patient at wakemed, you will learn many important things about caring. Discharge instructions wrapping your stump below the knee.
Relax the stretch and secure the bandage by going around the limb once. Youll probably need to keep your limb wrapped or keep it in a shrinker sock at all timesexcept when you. This monitoring may prevent troubles caused by getting the socket fitting worth. Avoid any loose material at the end where swelling can accumulate by keeping the shrinker pulled up and as high over the knee as possible. Wrapping elastic bandage ace wrap for below the knee amputation. Postamputation pain is the most common presenting residual limb issue and amputee complaint. Lift your residual limb up toward the ceiling, keeping your knee straight. Specialized amputee team and shaping but it requires skilled technique. It is normal to have swelling in your residual limb in the early days. In a wheelchair you can use an amputee board, and on a regular chair use a second chair of the same height to support your residual limb. Twelve patients with below knee amputations were assigned one of two methods for wrapping the residual limb.
Wrapping your residual limb landmine survivors network. Swelling must be reduced so your residual limb will fit into the socket of a prosthesis. Wrapping elastic bandage ace wrap for above the knee. Residual limb complications and management strategies. Shrinkers are usually provided within the first 12 weeks after the amputation.
There are several shaping methods used for the below knee amputee. Lytra is an affordable prosthetic leg that allows below knee amputees to take shower freely and clean their residual limb safely. Position of residual limb and fit of knee immobilizer if bka. To prepare the residual limb for prosthetic usage, while providing protection to the incision and limb and maintaining an optimal environment for wound healing.
The physical toll is immense, as is the potential emotional impact on both the patient and their family. Targeted muscle reinnervation technique in belowknee. All subjects were recent unilateral, below knee amputees with either a primarily healed residual limb or a secondarily healed granulating wound edge. Aka above the knee amputation, transfemoral amputation bka below the knee amputation, transtibial amputation residual limb the portion of the leg remaining after an amputation, sometimes referred to as a stump or residuum. The lengthening was greater than 100% and resulted in a bka residual limb of 15 cm. Weight bearing, massage, tapping, and residual limb wrapping are all commonly utilized interventions that facilitate desensitization amputation neuroma is a bundle of nerve endings that group together an can produce pain due to scar tissue, pressure from the prosthesis or tension on the residual limb. Transfemoral above knee exercise manual how to use this manual how to use this manual use one new manual for each new patient you treat. Secure bandage by wrapping across back, around shoulders and. The clinical practice guideline is designed to achieve several specific goals. Step 5 wrap the bandage behind your back and around your trunk, just below your waist. Your rehab team will likely include doctors, physical and occupational therapists. Your healthcare provider will prescribe a compression stocking to shape your residual limb. Reviews of posttraumatic lowerlimb amputees, when compared with agematched controls in health surveys, demonstrate that amputees often have decreased physical and mental health scores 15, 16.
Care of your wounds after amputation surgery amputee coalition. Lower limb amputation patient education notebook wakemed. For answers to questions not covered here, feel free to. Transtibial below knee residual limb edema and shape. Below the knee amputation discharge care what you need. Begin in front, just above the knee and wrap the ace around the leg to anchor it. Ace wrapping after amputation prepares for fitting of artificial limbs prostheses. Wrapping elastic bandage ace wrap for below the knee amputation 1. Avoid using safety pins, clips or adhesive tape to reduce injury to the skin. Below the knee bka, where the leg is removed below the knee joint. Continue in a figure eight fashion until your residual limb is covered. Manual muscle testing mmt or gross measurement of the le and ue muscles is. This patient underwent 8 cm lengthening of a dysfunctional very short below knee amputation bka residual limb that was initially 7 cm in length. All subjects were recent unilateral, belowknee amputees with either a primarily healed residual limb or a secondarily healed granulating wound edge.
The overall goal of amputation rehabilitation is to optimize health status, function, independence, and quality of life of patients with a lower limb amputation. Sep 20, 2019 your limb will be treated with special compression bandages or compression socks to help heal the wound quickly. The bandageliner must be removed occasionally to check the residual limb for. Pay close attention to the skin behind your knee and on the bottom of your limb. Patient must check the condition of the residual limb such as changes in skin color and the absence or presence of wounds prior to use of prosthesis. Reviews of posttraumatic lower limb amputees, when compared with agematched controls in health surveys, demonstrate that amputees often have decreased physical and mental health scores 15, 16. This can make wearing a compression bandage painful and it may interfere with prosthetic use. Pull the ace wrap diagonally, in an upward direction to secure the wrap in place upon itself.
Below the knee amputation is surgery to remove your leg below your knee cap. The very end or bottom of your residual limb stump. The residual limb must be washed daily using water and unscented skinfriendly soap. After below the knee amputation, it is important to prevent the hip from staying in a bent or flexed position. Amputation limb ace wrapping w doctor u wanna know ep. Preparing your residual limb for a prosthesis articles. Early postsurgical prosthetic limb fitting in dysvascular. Vadod clinical practice guideline for rehabilitation of lower limb amputation goals and outcomes. Below knee amputee home exercise program it is important that you take an active role in your rehabilitation. It is important to remember that the earlier the onset of rehabilitation, the greater the potential for success will be. Work with your prosthetist to maintain proper prosthetic alignment and to choose prosthetic components that are appropriate to your needs. It is obvious to those of us in the field of prosthetics that the accuracy of the socket fit is dependent largely upon the accuracy of the impression of the residual limb. The residual limb experimental group was treated with rigid plaster cast dressings with early postsurgical prosthetic limb fitting and progressive weight bearing ambulation.
The patient needs to receive physiotherapy treatment early to avoid complications such as joint contractures, pathological scars and depressed psychological state. A prerequisite for total contact and good coupling high stiffness of the prosthetic socketresidual limb interface is a constant residual limb volume. Marks 4 in the united states zes%ibed tb point of the shoulder and axilla as landmarks for both aboveelbo and belowelbow amputees, and the perineum as a reference point, both aboveknee and belowknee amputees. Wrapping a below the knee stump wrapping your patients amputation stump with elastic bandages helps protect the healing tissue, hold the wound dressing in place, reduce swelling, and shape the residual limb for a prosthesis. These are tight, stretchable garments that reduce swelling in a residual limb following surgery. When wrapping the end of the limb, use a figure8 pattern. Once your residual limb is covered, bring the wrap up around your waist to anchor the bandage. In geneva, stump length was measured from below the nearest join 3 during the 1930s. The residual limb of transtibial amputation tta prosthetic users is threatened daily by pressure ulcers pu and deep tissue injury dti caused mainly by sustained mechanical strains and stresses.
Volume changes occurring in postoperative belowknee. Directions for wrapping with an elastic bandage below knee, below elbow and aboveelbow amputations 1. Pta exam amputation and prosthetics flashcards quizlet. In order to proceed to using a prosthesis it is vital to have a well shaped residual limb. The team will also advise you on how to wash and take care of your residual limb. Isherwood states that elastic wrap bandaging is unreliable and dangerous. Marks 4 in the united states zes%ibed tb point of the shoulder and axilla as landmarks for both aboveelbo and belowelbow amputees, and the perineum as a reference point. After limb amputation, an area of hypersensitivity can develop along the healed surgical incision. Using a 4inchwide elastic bandage, go over the end of the limb, slightly stretching the bandage. Lytra allows the bottom of the limb to be exposed in air for amputees to get a fulldecent wash in the shower. Angle the wrap toward the end of your residual limb and toward the outside corner.
Your residual limb should be rewrapped every 4 hours. The patient should be independent with the exercise program and also understand. The following exercises must be done every day to prevent complications. Step 3 keep wrapping around the limb until all of your skin. The level of compression can be assessed based on skin discolouration or temperature. A figureeight method is used in the wrapping applied bandage smoothly, evenly, and not too tightly form the distal to the proximal end of the residual limb. Desensitize your residual limb, following the instructions of your physical or occupational therapist. If you have a belowknee amputation, wrap your residual limb so your knee can still move. Stump wrapping a stump shrinker prepares your residual limb for prosthetic fitting by shaping and shrinking it. How to apply ace wrap for a patient with a below knee amputation.
Circumferential wrapping is carried out from the lateral to the medial aspect, when viewed from the front, in order to avoid an terior displacement of the gastrocnemius fig. Directions for wrapping with an elastic bandage belowknee, belowelbow and aboveelbow amputations 1. Approximately 25 percent of major limb amputees will develop chronic localized symptomatic neuromas and phantom limb pain in the residual limb. This will also help prepare your residual limb for a prosthesis. A prosthesis was attached to the circular external fixator allowing. As you wrap, make sure that the bandage puts firm pressure. Techniques are demonstrated and reasons for doing so are provided. Bend the knee of your residual limb as far as possible. Acute postsurgical management of the amputee physiopedia.
Patients should be cautioned that the skin over the residual limb is. Transtibial below knee residual limb edema and shape management recommendations. Next, wrap upward, covering as much of the thigh as you can. See how to wrap an abovetheknee amputation stump in the january issue of nursing2003. Volume changes occurring in postoperative belowknee residual. You may need an amputation because of an injury, a tumor, or an infection. Using a washcloth, scrub gently over all surfaces of the residual limb. Ottobock care products can make residual limb care and cleaning easier figure 4. Ace wrapping a residual limb with a below knee amputation.
Comparing the effectiveness of elastic bandages and shrinker. Use clean, running water and a mild antibacterial soap. Run the bandage across your pelvis and over the hip joint. No residual limb had previously been subjected to any shrinking method. Below the knee amputation discharge care what you need to. Work with your prosthetist to maintain proper prosthetic alignment and to choose prosthetic components that are appropriate to. Compression using an elastic bandage, a tubular bandage, or shrinker sock applied to the residual limb aids in this process. Anchor the end of the wrap with the velcro closure. Wrapping your stump keeps the limb from swelling and shapes it so that it fits more comfortably in a prosthesis. Youll probably need to keep your limb wrapped or keep it in a shrinker sock at all timesexcept when you bathe or wear a prosthesis. Problems with your leg veins or arteries, or complications of diabetes may also cause you to need an amputation. Pdf comparing the effectiveness of elastic bandages and. Revision for pain a 30yearold male with an aboveknee amputation secondary to trauma with a ninemonth history of poor prosthetic fit.
It usually starts after the dressing is reduced and drains are removed 3 4 days postop and continues. Complete second hip spika by wrapping across the abdomen and around the trunk. This helps prevent creases from forming in your scar. Information for upper limb amputees and their families. Hip abduction slide your residual limb out to the side as far as possible. The results indicate the elastic shrinker sock to be more effective in decreasing residual limb volume. The part of your leg that is not removed is called a residual limb. Belowknee stump of nonischemic patient immediately after closure. Allowing it to move outward may make it hard to walk with a prosthesis later. Amputee rehabilitation lynn cunningham, pt, dpt helena lax, md mark nielsen, cp, atc. Refer to belowknee or aboveknee amputation manual provided by physiotherapy for residual limb care at home.
Special desensitization exercises can help decrease this uncomfortable sensation. Bandaging and shrinkers also decrease pain, phantom pains, improve wound healing and. Residual limb hygiene is also very important following wound healing. Keep your residual limb flat, with your knee as straight as you can. Dont prop your residual limb on pillows or blankets when you sit or lie down. Bandage residual limb apply residual limb shrinker reinforce correct positioning and care of residual limb. Increase the stretch and go to one side of the center. Refer to below knee or above knee amputation manual provided by physiotherapy for residual. Without appropriate application there is the risk of too much proximal compression, tissue strangulation and pressure damage, though these complications are not well documented. Begin with the wrap just below your knee on the inside part of your leg. In most cases, the surgical wound closes within the first three to four weeks and a scar is formed. Management of residual limb pain amputee coalition.
Twelve patients with belowknee amputations were assigned one of two methods for wrapping the residual limb. There are different sources of residual limb volume change, all of which may influence socket fit and function. This guide serves as a gateway to various resources to help with both presurgery preparation and postsurgery recovery. Transtibial below knee amputation advanced prosthetics center. When using an ace bandage, always wrap in a diagonal direction. Sep 17, 2014 postamputation pain is the most common presenting residual limb issue and amputee complaint. Physiotherapy following lower limb amputation protocols and reference material 2006 prepared by the physiotherapy departments in swahs western cluster nepean hospital, blue mountains hospital, springwood hospital. Even highly functional and active amputees frequently perceive physical limitations and experience. Sep 20, 20 options for tensor wrapping, possible positions and how to perform a 4 tensor wrap for a patient sitting upright. However, a prosthetic limb is not a substitute for a sensate limb with residual motor function. Surgery was performed to remove excess soft tissue 1. Step 3 as you move up the leg, wrap the bandage above the knee.
151 801 35 815 307 1163 1201 600 1406 246 1265 922 944 1500 591 330 1182 215 346 84 1046 1330 359 341 1245 290 607 249 1062 505 372 1448 1035 506 1328 1044