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September 2005 • Vol. 1, No. 3
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Advancing Orthotic and Prosthetic
Care Through Knowledge
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2005 FLO-TECH® O&P Systems
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Figure 1
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By Donald Shurr, CPO, PT
In 1922, Wilson reported using plaster casts fitted with wooden or metal pylons for early ambulation. Berlemont, in France and Weiss later in Poland, and Burgess in the United States, reported using this system; only these were applied in the operating room immediately following the surgical procedure. These systems allowed for early weight bearing and quicker time to final prosthesis, as reported by numerous authors. A careful review of these papers reveals most to be anecdotal, but the enthusiasm spread throughout the prosthetic community.
The literature reported several objectives accomplished by the use of these systems. Most of the early systems provided some degree of protection to the fresh wound. Falls were common and remain so today. The thigh-level systems, whether plaster, fiberglass, or later thermoplastics, prevent knee-flexion contractures.
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Figure 2
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Systems allowing for the attachment of a pylon and prosthetic foot can allow patients to walk partial weight bearing as early as postoperative day two, depending on physician preference, wound status, and other potential complicating factors such as diabetes. The APOPPS™ (Adjustable Post-Operative and Preparatory Prosthetic System) (see figure 1), by FLO-TECH® O&P Systems, Inc. consists of the FLO-TECH-TOR™, which provides protection from trauma caused by scrapes and impact injuries and flexion contractures until the wound heals, the VCSPS™ (preparatory socket), and the UFOS™ (Universal Frame Outer Socket), which accepts both the protective and the preparatory sockets and allows for the attachment of pylon and prosthetic foot components.
Once the wound is healing and the surgeon or managing physician recommends early weight bearing, the Rehab System (FLO-TECH-TOR™ and UFOS™) or the Prep System (VCSPS™ and UFOS™) may be employed. These systems consist of a flexible thermoplastic inner socket (FLO-TECH-TOR™ and VCSPS™) and a more rigid thermoplastic outer socket (UFOS™) (see figure 2).
Other systems available to the certified prosthetist include those made of air bladders as well as the traditional wrap casts and pylons. An advantage of these latter systems is that they are not easily removed by the patient. Lew Schon, MD, has published very detailed reports of the bladder systems and their positive results on many patients with diabetes, using prefabricated prostheses in a prospective study.
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Figure 3
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As with many other patient care techniques used by prosthetists and orthotists, careful attention to detail often spells the difference between success and failure. Close communication with managing physicians is also important so that each can bring his or her expertise to a successful outcome for the patient.
A second group of patients, albeit a smaller number, with similar needs are those who undergo a transfemoral amputation. Unlike the transtibial amputee, fewer options exist for this group. In our hands these systems are used for the patient with an amputation secondary to a bone or soft tissue tumor and for whom all other options have been rejected. These patients have both length and circumferential differences, making conventional sockets difficult, especially in the early weeks following surgery. This group of patients can ambulate using a partial weight bearing limitation as the
prosthesis allows for a safer and less energy costly gait.
FLO-TECH® has a companion system for patients at the transfemoral level, the complete APOPPS-TF™ system. It offers the same protection, adjustability, and weight bearing capability as the TT version. And using the endoskeletal system allows the knees to be substituted as many of this group may be more active than older, dysvascular amputees of the same anatomical level (see figure 3).
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Figure 4
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The APOPPS™ and the APOPPS-TF™ allow the surgeon to inspect the wound healing daily and the patient to begin walking on day two. Properly instructed patients report an advantage of the FLO-TECH® system is that by simply adjusting the straps and bands on the socket they (the patients) usually do not feel the need to remove the system. As healing occurs, socket modification is done using circumferential straps to tighten the socket, and the addition of stump socks offsets atrophy and volume changes. The VCSPS™ and APOPPS-TF™ are adjustable in AP, ML, and circumference at all levels and as such may provide optimum comfort without the need for additional stump socks, although the cushioning provided by adding more stump socks is a comfort option. Both TT and TF systems are designed with suspension systems to reduce the chance of pistoning and the friction that goes with it. One should expect more pistoning during the early stages of ambulation with the FLO-TECH-TOR™ and the APOPPSTF ™, as these sockets are designed so as not to adversely resist distal migration (see figure 4). The distal pads used in the socket are lively and will return to their original shape immediately after pressure is removed; thus the pads maintain distal contact at all times, prevent pooling of edema distally and promote healing.
The pylons used are endoskeletal, allowing the length, tilts, change of components and alignment to be adjustable throughout the life of the system.
FLO-TECH® provides custom fabrication of standard, ischial weight bearing, Symes, knee disarticulation, youth and children’s sockets and systems.
Anyone using these or other systems would be well advised to review the supplement to the Journal of Prosthetics and Orthotics (JPO), Volume 16, Number 3, July 2004. This is the official finding of the consensus conference on Post-Operative Management of the Lower Extremity Amputee published by the American Academy of Orthotists and Prosthetists.
Wilson PD. Early weight-bearing in the treatment of amputations of the lower limbs. J
Bone Joint Surg Am 1922;4(2): 224-247. Berlemont M. Notre experience de l’appareillage precose des amputes des members inferieurs aux Etablissements Heliomarins de Berck. Ann Med Physique 1961;4:213-218. Weiss M. The prosthesis on the operating table from the neurophysiological point of view. Report of the Workshop Panel on Lower Extremity Prosthetic Fitting. Committee on Prosthetics Research and Development. National Academy of Sciences. February, 1966. Burgess EM, Romano FL, Zettl JH. The management of lower extremity amputations: surgery, immediate postsurgical prosthetic fitting, rehabilitation. Bulletin TR 10-6. US Government Printing Office; 1969
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