1.26 Wound closure Flashcards
How does an amputation typically heal?
primary intention
classifications of dressings for amputations
- rigid dressings
- semirigid dressings
- soft dressings
What are the rigid dressings?
- IPOP
- removable rigid dressings
IPOP
immediate postoperative prosthesis
What is an IPOP?
- cast around residual limb (shapes perfectly)
- can add a post to the cast so they can use a prosthetic immediately
Who would receive an IPOP?
- usually only for traumatic amputations
- want to get them walking as soon as possible
What are removable rigid dressings?
- hard plastic shell with foam on the inside
- straps to hold in place
- education is particularly important here, remind them they need to get help
semirigid dressing
Unna dressing for control of edema
What are the soft dressings
- elastic wraps
- shrinkers
soft dressings: elastic wraps
- shape the leg right after surgery
- done so they can use a prosthetic limb
soft dressings: shrinkers
- have some pressure to help shape
- don’t have to wrap anymore
- used only once they’ve healed and gotten to the size they’re after
What is a big concern at the surgical site
can dehisce and create a wound
- undermining and infection along length of wound
- tissue hasn’t grown together
post-surgical management
- will have redness and swelling (measure girth)
- wrap
- mobilize
- I&D
What is I&D?
irrigation and debridement
standard surgical procedure (common)
phantom limb issues
- sensation
- pain
phantom limb sensation
- normal feeling sensations about the portion of the limb that’s gone
- not pain
phantom limb pain
- perceiving something as very painful even though it isn’t happening
- can be continuous, localized, diffuse, and limit ability to function
- anatomically no longer there, but that portion of the brain is
With amputees, the early stages of PT is focused on
desensitizing
- looking at the leg, touching it, thinking about where they’re touching it
- integration of sensation at the limb
- may do mirror therapy
Does phantom limb ever go away?
- may or may not
- typically trying to get it from continuous to intermittent
overall PT goals
- heal the wound
- edema control
- ROM and strength
- gait training
- transfers
- sitting and standing balance
- skin
- psychosocial aspects of loss
- HEP
What is involved with gait training?
crutches and walkers
- walkers safer
- crutches typically for younger, healthy people
Which is better for an amputee? Rolling or standard walker?
rolling: don’t want to have to pick it up every time
Gait is mostly
momentum
Why is gait so challenging for new amputees?
- every motion is a brand new contraction, motion against gravity
- there’s no momentum to be used with amputees
