List and describe the phases following post-ampuation surgery
- acute phase → time between surgery and D/C from acute care
- pre-prosthetic phase → time between D/C from acute care and fitting with a definitive prosthesis
- prosthetic phase → long term management (includes rehab and training w/prosthetic)
what is the primary goal in the acute/pre-prosthetic phase of trx?
prevention of contracture
what is the purpose of the post-op dressing?
meant to protect the incision and residual limb as well as foster healing, control edema, and manage pain
(primarily surgeon decision, but PTs can get some say if involved in prehab/pre-op care)
List the different types of post-op dressing
- compressive soft
- shrinker
- semi-rigid dressing
- IPOP
what is an IPOP?
immediate post-surgical prosthesis → prosthetic socket allowing for limited weight-bearing ambulation in the early stages
List the advantages/disadvantages of IPOPs
- Advantages
- great edema control
- excellent protection
- controls pain
- Disadvantages
- access to incision difficult
- more expensive
- requires training
what is a rigid/semi-rigid dressing (SRDs)?
list a cast or rigid dressing applied in the OR/recovery room
allows for immediate prosthetic fitting
dressing adheres to the skin
List the advantages/disadvantages of SRDs
- Advantages
- better edema control
- protection of limb
- Disadvantages
- frequent changing required
- no pt application
- no access to incision
what is a soft dressing?
most common/preferred post-op dressing
immediately post-op, limb is wrapped w/sterile gauze and covered w/compressive elastic bandage in figure 8 fashion
List the advantages/disadvantages of soft dressings
- Advantages
- easy to apply
- inexpensive
- easy access to incision
- Disadvantages
- little edema control
- frequent rewrapping
- inconsistent technique
why might a splint/immobolize be used during post-op?
encourages full knee extension (prevent knee flexion contracture)
*this is worn over the primary dressing
What things are included in a post-surgical evaluation/trx?
- General systems review/chart review
- post-surgical status
- pain level
- residual limb assessment
- ROM and strength
- functional status
- cognition/emotion
- post-op complication
what needs to be determined during a pain assessment post-operatively?
- location of pain
- type of pain
- nature of pain
- intensity of pain
- impact on functional activities
define phantom limb sensation
painless awareness of the amputated limb, possibly accompanied by tingling
what is phantom limb pain?
brain continues to recieve painful sensory messages from the nerves that originally carried messages from amputated limb
feelings of cramping, burning, pain
how might a PT treat pain in an amputee?
- dressing and compression help to desensitize limb
- pain education
- movement
- modalities
what is included in the residual limb assessment?
- limb length
- volume (circumference)
- degree of wound healing
- vascularity
where are the staring and ending points for measuring limb length in a TTA? TFA?
- TTA → medial joint line to end of limb
- TFA → ischial tub. or GT to end of limb
what things are included in the contralateral limb assessment?
- DVT screen
- diabetic foot screen (if appropriate)
- sensory testing
- Strength/ROM testing
List common DVT symptoms
- swelling (calf/entire leg)
- local tenderness along deep venous system
- increased redness/warmth
how do the landmarks change for goni placement in amputees?
if bony landmarks are still available use them,
but now the moving arm is the midline of the residual limb
all proximal joints remain the same
T/F: a contracture is the tightening of the muscle
FALSE
it is also changes to the joint capsule
why is positioning important for post-op care in amputee?
- critical to prevent contractures
- edema control
- patient comfort
- patient education
what key muscles are targeted in a TTA during AROM/stretching?
hamstrings
hip flexors
gastroc-soleus (contralateral)
