Eugene Rossouw Prosthetics

Below Knee Amputation Rehabilitation Process

Amputation

After the formalisation of the amputation, a compressive dressing or rigid dressing will be applied immediately after amputation to prevent swelling of the residual limb (stump) tissues. Controlling swelling is important as swelling of the soft tissues causes pain and can result in the suture site and stitches being put under undue tension.

• Residual Limb – immediately post-operation. The suture line visible at front where muscle and skin are attached to form a soft tissue pad over the bone.

• A wound dressing bandage is placed around the limb – the rigid dressing underneath the limb about to be closed.

• The rigid dressing applied. Air is sucked out of the rigid dressing, causing it to compact and rigidify.

Compression Therapy

After approximately 7 – 10 days, the wound dressing and compression dressing will be removed. The sutures can often be removed after approximately 14 days, depending on the suture site healing. For diabetic or vascular insufficiency patients, the healing may take a little longer.

Compression therapy of the residual limb can commence once the sutures have been removed. The compression therapy has the following advantages:

• It helps to control swelling
• By controlling swelling, it helps to reduce pain
• By controlling swelling, it promotes wound healing
• It reduces and shapes the residual limb soft tissues to be ideal for prosthetic fitting
• It therefore speeds up the rehabilitation process.

Compression therapy can be done by means of elastic bandages wrapped around the residual limb, or better, by means of silicone compression liners. The silicone liners are easier to apply and give consistent graduated compression (higher at the bottom – gradually getting less at the top).

• Post-Op compression silicone liner. Graduated thickness allows graduated compression – more at bottom, gradually less at top.

• The application of the compression therapy silicone liner to the residual limb

• The compression therapy liners are applied in a graduated compression therapy protocol where the silicone liner is used for slightly longer periods of time each day. As the residual limb volume and shape reduce, a smaller size compression liner is applied.
  
  This process is repeated until the prosthetist is satisfied that the volume and shape of the residual limb is suitable for the fitting of a diagnostic socket.

Casting, Manufacture and Fitting of Diagnostic Prosthesis

The diagnostic socket can serve as an interim prosthesis for short-term use to help further shape and reduce the volume of the residual limb. As the name implies, the diagnostic socket also serves to help determine any socket fitting problems, areas of residual limb discomfort and the correct alignment of definitive prosthesis.

• Taking measurements and casting the residual limb to manufacture the prosthetic socket.

• Below Knee Prosthesis with ‘’Diagnostic Socket’’ to determine comfortable socket fit and correct dynamic alignment.

Fitting of Final (Definitive) Leg Prosthesis

Once the residual limb volume and shape has stabilised, the definitive prosthesis can be manufactured. The correct alignment of the diagnostic or interim prosthesis can be transferred to the definitive prosthesis. The prosthetic components used in the diagnostic prosthesis (such as the foot, suspension lock and other attachment components) can be used in the definitive prosthesis. It is therefore simply a replacement of the prosthetic socket.

Cosmetic Covering of leg prosthesis (if applicable)

If the patient desires a cosmetic cover for the prosthesis, it will be the final procedure in the completion of the definitive prosthesis. This can be a simple foam shaped cosmesis covered with a cosmetic stocking, a basic silicone ‘’skin’’ or a high definition silicone "skin" cover that matches the skin colour, skin profile, toes and nails of the contra-lateral limb.