2. The APOPPS™ & APOPPS-TF™ by FLO-TECH® O&P Systems, Inc.
Robert N. Brown, Sr., CPO, FAAOP
CEO/Research & Design

3. The APOPPS™ & APOPPS-TF™
Adjustable Post-Op, Protective & Preparatory System for Transtibial & Transfemoral Amputations

4. Design Goals – Keep It Simple:
S-afe postop systems
I-mmediate access
M-odular sockets
P-rosthetic
Function & feel
Not “One Size Fits All”
L-ook custom
Not like “Off The Shelf”
E-arly, immediate, training & extended ambulation

5. DELAYED HEALING Main cause: Disease Chronic causes: Impact injuries
Microscopic injuries

6. The FLO-TECH-TOR™
Post-operative, protective or early fit socket provides:
Protection from scraping or impact injuries
Gentle donning and doffing for easy access & attentive wound care
Control and prevention of flexion contractures
Accommodation for bulbous, conical or cylindrical shapes
Monitored early weight bearing & shaping of the residuum
Early & training ambulation
When used with a UFOS™

7. The VCSPS™
Variable Circumference Supra Patella Socket (PSRD type or Preparatory socket) provides:
Knee flexion mobility
Gentle donning & doffing for attentive wound care
Early, training & extended ambulation
when used with the UFOS™
Early & controlled shaping of the residuum
Distal AP closure
Accommodation for fluctuating volume
Independence

8. The UFOS™ Universal Frame Outer Socket:
Sized to fit and accept either the FLO-TECH-TOR™ or VCSPS™
Attach the Pylon and foot
Removed in bed
Kept in the Physical Therapy Department
The residuum protected by continued use of the FLO-TECH-TOR™

9. The FLO-TECH-TOR-TF™
Post-operative, protective or early fit socket provides:
Protection from scraping or impact injuries
Gentle donning and doffing for easy access & attentive wound care
Accommodation for bulbous, conical or cylindrical shapes
Distal AP closure
Monitored early weight bearing & shaping of the residuum
Early, training & extended ambulation
When used with a UFOS-TF™

10. The UFOS-TF™ Universal Frame Outer Socket:
Sized to fit the FLO-TECH-TOR-TF™
Attach the Knee, Pylon and foot
Removed when the patient is in bed
Kept in the Physical Therapy Department
The residuum protected by continued use of the FLO-TECH-TOR-TF™

11. APOPPSTM Specifics
Modular socket system for transtibial amputations, available in:
Lengths of: 5” (child), 7" (youth), 7” (adult) & 9“ (adult) & custom
Left and Right
102 standard sockets, in 11 sizes
Circumferences 8” to 19” & custom
Sockets progress in 1” increments

12. APOPPS-TF™ Specifics
Modular socket system for Transfemoral amputations, available in:
12" socket length & custom
Left & Right
12 standard sockets in 3 sizes
Circumferences 16” to 27” & custom

13. Selecting the Proper Length
Transtibial Sockets:
MPT to distal end over bandages
Transfemoral Sockets:
Ischium to distal end over bandages
If less than 3/4” space between residuum and end of socket - SIZE UP
If no stock size available - CUSTOM

14. Selecting the Proper Size
Transtibial sockets:
Approximately 1 week post-op
Circumference: 2” to 3” from the distal end
Measure over light bandages & 2 socks
If measured over skin only, add 1”
Length: MPT to distal end
Left or Right
Prior to amputation
Estimated length
Estimated distal circumference
Add 2“

15. Selecting the Proper Size
Transfemoral sockets:
Approximately 1 week post-op
Ischial Circumference
Measure over light bandages & 2 socks
If measured over skin, add 1”
Length: Ischium to distal end
Left or Right
Prior to amputation
Estimated length
Ischial circumference
Add 2“

16. One APOPPS Three Prosthetic Programs: #1, The FLO-TECH-TOR
As protective socket only
Prevent and reduce flexion contractures
Monitor progress with instant access to bandages
Immediate, early or extended wear protective socket
Especially good for revision surgery and to prevent injury

17. One APOPPS Three Prosthetic Programs: #2, The Rehab System
(FLO-TECH-TOR & UFOS)
Same as FLO-TECH-TOR™ plus
Early and training ambulation
When the time is right
Usually 48 hours to 7 days after receipt of FLO-TECH-TOR™
Patient interactive
Involve the patient in their rehab

18. One APOPPS Three Prosthetic Programs: #3, The Preparatory System
(VCSPS™ & UFOS™)
Independent ambulation
2 weeks to 6 months post-op
Expedite care:
The APOPPS™
(FLO-TECH-TOR, VCSPS™ & UFOS™)

19. One APOPPS-TF Two Prosthetic Programs: #1, The FLO-TECH-TOR-TF
Use as protective socket only
Prevent scraping & impact injuries
Monitor progress with instant access to bandages
Immediate, early or extended wear protective socket
Especially good for revision surgery and to prevent injury

20. One APOPPS-TF Two Prosthetic Programs: #2, The Preparatory System
(FLO-TECH-TOR-TF™ & UFOS-TF™)
Early or training ambulation
Extended or independent ambulation
(2 weeks to 6 months post-op)
Expedite care:
The APOPPS-TF™
(FLO-TECH-TOR-TF & UFOS-TF™)

21. When should I use an APOPPS™ or APOPPS-TF™
All diagnoses & ages
In the OR
Early postoperative (24 to 48 hours post-op)
1 to 3 weeks post-op (cast change)
Any time protection or immediate, early or sustained ambulation, is ordered

22. Early Ambulation Protocol
Patient selection
Competent, coherent & cooperative
except in OR
Reasonable family or residence support
Reasonable upper body strength

23. Early Ambulation Protocol
Apply FLO-TECH-TOR™ or FLO-TECH-TOR-TF™
In OR or as soon as prescribed
Examine residuum before attempting distal pressure
Tighten all straps & bands before testing distal tolerance or attempting weight bearing
Apply pressure to distal end (up to 10% of body weight) to determine readiness for weight bearing
Examine residuum after testing distal tolerance
Apply UFOS™ or UFOS-TF™ 48 hours to 7 days post application of FLO-TECH-TOR™ or FLO-TECH-TOR-TF™ - when the time is right.

24. Early Ambulation Protocol
Weight bearing at 10%
Tighten straps and bands prior to standing
After weight bearing
Examine tissue – check for spotting
Excessive or continuous - contact physician, minor:
Record size & location and monitor
Wash and re-apply reticulated pad
Replace outer sock if soiled
Reapply FLO-TECH-TOR™ or FLO-TECH-TOR-TF™
MPT strap - 1 to 2 fingers loose

25. Early Ambulation Protocol
Progress to 20% weight bearing
Only after 2 days without pain or spotting
Repeat all above daily until patient is full weight bearing
Progress at 10% increments until patient ambulates independently and without incident

26. Practitioner Survey In December 1998 Survey
13 Practitioners responded on 94 patients
1 Bilateral
95 Transtibial amputation socket fittings

27. Diagnoses Diabetes = 55 = 58.50% PVD = 32 = 34.05% Trauma = 5 = 5.32%
Other = = %
TOTAL = 94 = %

28. Application Patient’s Room 38 = 40.00% Operating Room 17 = 17.90%
Rehab Dept./Center 16 = 16.80%
Nursing Facility 9 = %
Recovery Room 5 = %
Patients Home 5 = %
Clinic 3 = %
P&O Facility 2 = %
TOTAL SOCKETS 95 = %

29. How Was The APOPPS™ Used?
95 FLO-TECH-TOR sockets reported
54 (of 95) FLO-TECH-TOR Sockets
For protection only %
41 (of 95) advanced to Rehab System
(FLO-TECH-TOR & UFOS ) %
100.00%
19 Rehab advanced to Prep System
(VCSPS & UFOS )
19 of 41 – wearing 2 to 6 mos.) 46.34%

30. COMMENTARY The APOPPS™ provides & preserves quality.
It offers safe postoperative care (including ambulation) for: diabetic, elderly, circulatory dysfunction & traumatic amputees.
It allows prosthetists to adapt the prosthesis to meet the rehabilitation needs of their patient in a gentle, yet dynamic, and cost effective manner.