REMOVABLE RIGID DRESSING

1. REMOVABLE RIGID DRESSING Katrina Brown, Senior Physiotherapist Greenwich Hospital Presented at NSW PAR Meeting Nov. 2004

2. Postop Mx of Residual Limb • Soft dressings • Thigh Level Rigid Dressing • Removable Rigid Dressings • Prosthetic liners (ICEROSS)

3. Acute Care of Residual Limb with RRD • AIM: • Reduce oedema • Protection for residual limb (RL) • Promote wound healing • Reduce pain • Shape residual limb First Introduced by Wu (1979).

4. Reduce/prevent oedema • Non-expandible dressing • Protection • Distal aspect of RL often used for stabilisation in bed mobility and transfers • High risk of falls • Reduced sensation in dysvascular patients

5. Benefits of RRD • Reduction in or prevention of oedema • Promotes wound healing • Allows access to wound for inspection and dressing changes • Education of patient starts re. donning/doffing • Permits knee flexion • Ability to adjust fit • Protects RL while healing • Quick & easy to make • ? Cost effective

6. Research out there Smith et al. (2003). Postoperative dressing and management strategies for transtibial amputees: A critical review. Literature review • Body of RCT evidence poor • Mueller (1982) • Significantly less oedema (compared with soft dressing) • Wu et al. (1979) • Reduction in healing time from 109.5 days to 46.2 days (compared with soft dressing)

7. Research out there • Maclean & Fick 1994 • Trend towards earlier prosthetic fitting • Deutsch et al. (unpublished). Presentd at ISPO 2002. • Trend towards faster healing time • Indications in prevention of trauma in event of fall • Woodburn et al. 2004 • Trend towards limb reduction but not statistically significant. • Limitations with study

8. Fabrication of RRD with “Shapemate” • Ensure low profile dressing • Padding can be added for relief areas as required • Apply sock and cover with plastic bag or glad wrap • Have sock/bag held taught or use suspender strap

9. Soak sock and unravel portion to assist in donning • Fold at mid patella tendon allowing enough at back of cast to allow knee flexion • Alternatively trim off above knee and fold twice to create collar

10. Continue down with roll to create second layer for added protection • Trim off excess and smooth to avoid rough edges

11. No excess moulding required • Keep moist to assist curing process

12. Once hard to tap, mark front centre and remove to dry • Allow time for curing process and then towel off excess moisture • Re-apply to patient, with sock underneath

13. Removable Rigid Dressing • Use tubigrip to suspend, or lightweight sock with thigh strap to secure • Add socks as required to maintain fit • Monitor for pressure

14. Hints for “Shapemate” • Ensure malleable in packet before opening • Cool storage temperatures can be problematic. • Soap can assist in emulsion • Enough material for double layer adding further protection

15. References • Smith et al (2003). “Postoperative dressing and management strategies for transtibial amputations: A critical Review.” Journal of rehab. Research and Development, 40 (3), 213-224, May/June. • Woodburn et al (2004). “A randomised trial of rigid stump dressing following trans-tibial amputation for peripheral artery insufficiency.” Prosthetics and Orthotics International, 28, 22-27. • Deutsch et al (2002). “Removable rigid dressings versus soft dressings: A randomised study with dysvascular trans-tibial amputees.” Proceedings of the ISPO ANMS Annual Scientific Meeting, Alice Springs NT June 2002. • Wu, Y. (1992). Removable Rigid Dressing for Residual Limb Management. In L. Karacoloff, C. Hammersley & F. Schreider (Eds.). Lower extremity Amputation: A guide to Functional Outcomes in Physical Therapy Management. Second Edition. Gaithersburg: Aspen Publication. • Maclean & Fick 1994. “The Effect of Semirigid Dressings on Below-Knee Amputations.” Physical Therapy, 74(7), 668-672.

16. Special thanks to Reis Orthopaedics, for supply of “Shapemate”. 25 John Street Lidcome. Ph: 9643 1444