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 (unpublished).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