There are two basic modes of dressings to shape and help protect the sutures on your residual limb:
- Most of the time, soft dressings are prescribed to allow for daily dressing changes and skin evaluations. After the dressings are applied, the initial application of an ACE wrap bandage is applied by your nurse, physical/occupational therapist or prosthetist. Often, the ACE wrap will be measured for a custom fit shrinker sock. The use of the ACE wrap and/or shrinker is critical in the shaping and control of swelling in the residual limb. You will be required to wear the shrinker/ACE wrap after massaging. The shrinker is worn until it is felt that the residual limb is stable from swelling. You may be required to wear a knee immobilizer to prevent knee contractures.
- Rigid dressings consist of a plaster of paris or a fiberglass tape shell with soft sterile lining against the skin. Often a simple tube or alignment device with an artificial foot is attached to the end of the rigid dressing for minimal weight bearing and so that walking can begin immediately. This rigid dressing is generally changed in two weeks for evaluation of the stump for healing, and a new tighter sterile rigid dressing is applied.
Two to three weeks after your surgery, you will return to your doctor for your first post operation visit and have your staples removed. Your second post operation visit will be two to three weeks later. At this visit, any remaining sutures will be removed. Generally, at the second post operation visit, the doctor will write a prescription for your prosthesis.
Please Note: The above is a typical post operation guideline. However, each doctor is different and results may vary.
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Once your residual limb has reached an acceptable shape, you are seen for the measuring and molding of the residual limb for a prosthesis. At this time, you should have:
You will be asked to fill out a fact sheet for contact purposes, and sign any applicable insurance forms. Your appointment will take approximately 45 minutes to two hours, depending on the complexity of the prescription, for the evaluation. This initial process is generally performed at our office.
During the second visit, which is usually within two to three weeks, a socket is fabricated and designed to minimize pressure over areas of less tolerance (boney areas, scar tissue, nerve ends, sores, etc.) and monitor and reduce weight bearing on tolerant skin areas. The pressure marks on your residual limb are evaluated closely to determine appropriateness of the fit.
Expect general tightness and possible discomfort initially. Your residual limb has never been required to take your full body weight prior to the amputation. Tolerance to this new demand may take weeks or even months to become conditioned.
The socket is placed on an alignment device to allow the prosthetist to make any required adjustments in length and alignment to improve comfort and gait. The appropriate suspension is also determined. This visit is sometimes very demanding, and requires one to two hours to successfully reach an acceptable result. Should the initial fitting not be satisfactory, an additional fitting may be required, or additions to the initial prescription could be considered.
When you and your prosthetist determine that the device is fitting well, you can take the temporary prosthesis with you, following the wearing schedule outlined by the prosthetist.
It is recommended that you work with a physical/occupational therapist on prosthetic gait training.
Generally, in the case of an upper extremity amputation, you are trained by an occupational therapist knowledgeable in prosthetics.
It should be noted that the term “temporary prosthesis” only implies that we expect your residual limb to continue to change in size/shape due to the pressures from the socket, and the increased circulation from greater activity. The “temporary” is structurally sound and anatomically designed for each individual, but is not cosmetically finished. This allows greater adjustability, and will lessen the overall cost initially.
As you become more proficient with the use of the temporary prosthesis, you may find the need to add additional prosthetic socks to tighten the fit. Changes in the size of your residual limb are expected and sometimes inconsistent. Close maintenance is critical by the therapist and you. Should the socks not provide the required comfort and/or function, the prosthetist should be contacted as soon as possible. Some situations can not be corrected prosthetically and a referral to your doctor may be warranted.
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- A prescription for the prosthesis from your doctor.
- All insurance information to determine what deductible and remaining balance is your responsibility prior to the delivery of the prosthesis.
- A pair of shoes — either new or slightly worn — to determine the foot size and heel height, and shorts if you are being measured for a lower extremity prosthesis.
- Wear your ACE wrap/shrinker at all times, including the first visit, so the prosthetist can evaluate whether
there is a need for adjustments or replacement.