A Manual for Below-Knee Amputees

Preparation for Fitting the Prosthesis

In general the earlier a prosthesis is fitted the better it is for the amputee. One of the most difficult problems facing the amputee and the treatment team is edema, or swelling of the stump, owing to the accumulation of fluids. Edema will be present to some extent in all cases, and it makes fitting of the prosthesis difficult, but certain measures can be taken to reduce the amount of edema.

The use of a rigid dressing seems to control edema. After the rigid dressing has been removed and when a prosthesis is not being worn, elastic bandages are used to keep edema from developing.

The patient is taught the proper technique for bandaging and is generally expected to do this for himself as shown on the next page.

For the average adult, one or two elastic bandages four inches wide are used. During the course of the wrapping, tension is used to maintain about two-thirds of the maximum stretch.

The stump should be bandaged constantly, but the bandage should be changed every four to six hours. It must never be kept in place for more than 12 hours without re-bandaging. If throbbing should occur, the bandage must be removed and rewrapped.

Special elastic "shrinker socks" are available for use instead of elastic bandages, and while not considered by some to be as effective as a properly applied bandage, a "shrinker sock" is better than a poorly applied elastic bandage.

Whether an elastic bandage or a shrinker sock is used, it should be removed at least three times daily and the stump should be massaged vigorously for 10-15 minutes. The bandage or sock must be reapplied immediately after the massage.

Special Note:
Regardless of the functions provided by the most sophisticated mechanical devices, the most important factors in the usefulness of an artificial leg are fitting of the socket and alignment of the various parts with respect to the body and with respect to each other. Fitting and alignment are difficult procedures that require a great deal of skill on the part of the prosthetist and a great deal of cooperation on the part of the patient. During fitting and alignment of the first prothesis, it is necessary for the prosthetist to train the amputee in the basic principles of walking in order for the prosthetist to arrive at the best set of conditions for the amputee. Fitting affects alignment, alignment affects fitting, and both affect comfort and function. In addition, extensive training is carried out later by the physical therapist.

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Copyright 1996 - Alvin L. Muilenburg and A. Bennett Wilson, jr.

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