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Wound Care, Preventing Contractures
By Miki Fairley Fostering wound healing and preventing muscle contractures are
important aspects of postoperative therapy.
"After amputation surgery, the first order of business is fostering
wound healing," says Joan Edelstein, PT, MA, FISPO, adjunct faculty
member of Columbia University, New York, and former associate
professor of clinical physical therapy and director of the Columbia
Program in Physical Therapy.
Edelstein outlines three principal types of wound dressings:
elastic bandage, rigid dressing, and semi-rigid dressing.
( Editors note: For more information on wound care and types of
dressings and their advantages/disadvantages, see the report on the
American Academy of Orthotists and Prosthetists (the Academy)
Clinical Standards of Practice report on "Postoperative Management of the Lower
Extremity" .)
Edelstein favors the Unna boot, a semi-rigid dressing with
calamine, glycerin, and gelatin. "Its easy to apply and removeall
you need is bandage scissors," Edelstein says. "Its also somewhat
sticky, so it will adhere to the skin and the patient thus will not
need a waist belt or shoulder harness. Patients appreciate this
because they dont want any more apparatus than is absolutely
necessary. We did a comparison study with elastic bandages; the
Unna was far, far more successful, especially for people with
transfemoral amputationsand its about 150 years old!"
The study, titled "Unna and Elastic Postoperative Dressings:
Comparison of Their Effects on Function of Adults with Amputation
and Vascular Disease," by C.K. Wong and Edelstein, was published in
the Archives of Physical Medicine and Rehabilitation,
September 2000.
Contractures are easy to prevent but difficult to correct, observes
the National Institutes of Health (NIH). The NIH provides these
guidelines for persons with lower-limb amputations:
- The amputee must not lie on an overly soft mattress, use a
pillow under the back or thigh, or have the head of the bed
elevated. Standing with the transfemoral residual limb resting on a
crutch should be avoided. All these practices can lead to hip
flexion contractures.
- The amputee must not place a pillow between the legs, since this
creates a hip abduction contracture.
- A transtibial amputee must not lie with the residual limb hanging
over the edge of the bed, with a pillow placed under the knee, or
with the knees flexed, and must not sit for a long period of time
in order to avoid knee flexion contractures. The transtibial
amputee should sit with the knee extended on a board under the
wheelchair cushion with a towel wrapped over the board.
- Amputees should lie prone for 15 minutes three times a day to
prevent hip flexion contractures. The amputee who cannot lie prone
should lie supine and actively extend the residual limb while
flexing the contralateral leg.
Read the related article "Preprosthetic Therapy: Is It Needed?
Does It Help" in the October 2008 issue of The O&P
EDGE.
Table Of Contents - September 2008
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