Prosthetics and Orthotics International

The effects on tissue oxygenation of postoperative adjuvant oxygen have been studied in a group of 20 patients undergoing below-knee (BK) amputation for vascular disease. Ten patients received no therapy, the remainder receiving 28% oxygen for 48 hours following surgery. The results showed that the trancutaneous p0₂ in the amputation flaps fell significantly by some 20 mmHg (p<0.01) following surgery and that this fall was prevented by the use of adjuvant oxygen. The fall was not observed in the non-amputated limbs. Tcp0₂ took almost two weeks to reach its pre-operative levels in the amputated limbs.

The effect on stump healing of adjuvant oxygen therapy was investigated in a randomized controlled trial in a series of 39 patients undergoing BK amputation. There were 22 patients in the control (untreated) group and 17 in the treated group (adjuvant oxygen for 48 hours). In the treated group 14 patients healed primarily and three amputations failed. In the untreated group 14 limbs healed primarily, one secondarily and there were 7 failures. The pre-operative transcutaneous values in the stumps which failed (26 mmHg±14) was significantly lower (p<0.005) than in those which healed (40 mmHg±9). The mean pre-operative Tcp0₂ in the patients in whom healing occurred in the treated group (35 mmHg±10) was significantly lower (p<0.001) than the mean pressure observed in the untreated group (44 mmHg±9).

The value of revision surgery when carried out more than six weeks after initial amputation of the upper or lower limb was assessed. When performed for stump and/or phantom limb pain alone, only 33/95 (35%) obtained satisfactory results after one revision; 25/95 (26%) of the patients required four or more surgical procedures without relief of pain. However, when carried out for local specific pathology, the results of surgical revision were 100% successful, even if the procedure had to be repeated once in 15% (28/189) of this group of patients. Transcutaneous nerve stimulation appeared to offer no long lasting relief of pain following amputation surgery.

Splintage plays a major part in the management and rehabilitation of the hand following injury, infection and operation. It is essential to have a simple, comfortable, and firm but flexible splint. This should be available “off the shelf”, but be acceptable to the patient and to the treating clinician.

This paper will describe a splint which not only has these qualities, but is cheap and is re-usable after washing.

The splint is made of high density Plastazote and is available in two sizes for each hand. It is moulded into the shape of the functional position of the hand and can easily be trimmed with bandage scissors to give a precise fitting. The splint has been evaluated following surgery on fifty hands. Its fabrication, use and simplicity are discussed.

The effects of introducing the Team Approach to the management of the lower limb amputee has been assessed in a consecutive series of 233 patients over a five year period.

During the first, year, baseline data was collected and during the subsequent yearly phases the effects of introducing a physiotherapist co-ordinator, visiting prosthetist and medical officer from the local Artificial Limb and Appliance Centre (ALAC), and finally trained surgeons were studied. During the final phases of the study, the effects of changing team staff were monitored.

The results have shown that only when the full Team Approach is adopted are the best results achieved, but that, once this approach is established, staff changes can be made without serious reductions in effectiveness. The study has shown that the team can reduce in-patient stay by 20 days; reduce the need for post-discharge physiotherapy by 94%; increase the proportion of patients discharged with a prosthesis more than fivefold and increase the effectiveness of long term rehabilitation threefold.

Relief from external pressure and repetitive stress is a main concept in treating diabetic neuropathic ulcers. Ulcers on the tip of the big toe may be caused by abnormal extension of the big toe, which can be diagnosed only by observing the patient during barefoot walking. A flexor pad underneath the big toe eliminates the phenomenon, bul in case of rigidity of the toe, extremely roomy toe boxes must be prescribed. Out of a series of 272 diabetic patients with skin lesions on the feet 18 suffered this phenomenon, in one case with bilateral ulcerations. Fifteen ulcers healed and below the knee amputation had to be carried out in 4 legs due to ischaemia.

The foot loading characteristics of 100 consecutively attending amputees wearing their definitive prostheses were studied during their routine visits to the Artificial Limb and Appliance Centre. Results were compared with observations on 100 age and sex matched controls who were free from any locomotor disability. The parameters measured were the percentage of body weight borne on each foot, the positions of the centres of pressure under each foot and the position of the overall centre of foot pressure. The results demonstrate the range of variability of these parameters in normal subjects of different ages and provide preliminary indications of the patterns associated with different types of prostheses and different levels of amputation. The information was collected using the Double Video Forceplate (D VF) a tool developed for the rapid assessment of stance, at University College London Bioengineering Centre. It is proposed that the DVF may be useful in assisting prosthetic alignment, in clinical teaching of prosthetists, physiotherapists and doctors and in monitoring of patients with lower limb amputation.

A severely paralysed child whose trunk as well as both lower limbs is affected needs an aid for the basic needs of sitting, standing and other activities of daily living. Often a number of aids such as standing table, adapted chairs, commode etc., is required to meet basic needs. Special equipment has been designed for this multipurpose use, which does not occupy much space in a house and is portable. This equipment enables the parents to manage the handicapped child at home.

plaster of Paris (P.O.P.) bandage has been the pre-eminent external splinting material for over 150 years and from time to time synthetic alternatives have been tried. So far none has seriously challenged the dominance of P.o.P. as a primary or secondary material in the management of fractures. The recent introduction of Polyurethane coated fibreglass bandage appears to offer a more serious challenge than previous contenders. This technical note reviews bandage type splinting materials and explains some of the properties of the PU materials.