How to combat oedema ?

Oedema can be overcome mainly by using elastic bandages which must be applied each time the patient is not wearing the prosthesis.
Finding the correct position in bed or in the wheelchair also helps combat oedema.

How to bandage the stump ?

Bandaging

Use spica bandaging to ensure even pressure.
To avoid too much pressure on certain bony parts (for example the tibia ridge, the rotula) as well as ensuring containment within concave areas, it may be necessary to use cotton wool pads around contoured parts.
Special care must be taken with diabetics and particularly patients with sensitivity disturbances. The bandage must avoid the rotula and small cotton wool pads may be needed around the tibia ridge. This must be frequently monitored.

What type of bandage ?

We recommend SAMA RX elastic bandages, (Salzmann Medico Unterstrasse 52 CH-9001 St-Gallen) 8-10cm wide for a tibia stump and 12-15cm wide for a femur stump.
To bandage a femur stump it may be necessary to sew several bandages together to make it sufficiently long.
Special support socks designed for stumps are manufactured in various shapes and sizes, for which measurements need to be taken. However, they are in theory less effective than a well-applied bandage.

When to start using a prosthesis ?

The device can be fitted fairly rapidly as soon as the stitches have been removed, or even a little before.
We fit the patient with the final prosthesis straight away, bearing in mind that it will need to be modified as the stump loses its oedema and stabilises.

How to put on the prosthesis ?

Below knee amputation and disarticulation of the knee

As a general rule it is necessary to put a fine sock (nylon) then a thick sock (cotton or wool) over the stump before putting on the softsocket. It is essential to put a fine sock (Nylon) over the cuff before putting on the prosthesis. (If not there is a danger of not being able to remove the prosthesis!).

Femoral amputation

There are several different fitting aids which all operate on the same principle:
Try several different ones to see which is the most suitable.

Elastic bandage

Roll the bandage round the stump beginning at the groin. Thread the end of the bandage through the valve hole and put on the prosthesis. Pull the whole length of the bandage through the valve hole while performing a gentle "pumping" motion. (place full body weight onto then off prosthesis).

Tubular stockinet

Pull the stockinet over the stump up to groin level, and thread the other end through the valve hole while performing a gentle "pumping" motion. (place full body weight onto then off prosthesis).

Stocking with tapes

Pull the stocking over the stump up to groin level (the tapes must be sewn to the proximal side), thread the other end of the stocking and the tapes through the valve hole and put on the prosthesis. Pull the entire stocking through the valve hole by pulling alternately on the tapes and the stocking itself, while performing a gentle "pumping motion" (place full body weight onto then off prosthesis).

The Quickfit

Roll back the Quickfit in a double layer to the white marker. Pull it over the stump up to groin level, thread the loop through the valve hole and put on the prosthesis. Pull the entire Quickfit through the valve hole, while performing a gentle "pumping motion" (place full body weight onto then off prosthesis).

How long to wear the prosthesis initially ?

It is important to wear the prosthesis as long as possible right from the beginning of the rehabilitation process.
The goal is to be able to wear it for the whole day.
However, it is essential to check the state of the skin at regular intervals : After 5 mins, 10 mins, 20 mins, one hour etc.

How to check for pressure points ?

It is important to watch for possible pressure points by checking the state of the skin on the stump.
For diabetics or patients with sensitivity disturbances these checks must be carried out more frequently.
Redness of the rotula, the head of the tibula, the crest of the tibia, the condyles of the femur are the result of pressure points and may require an adjustment of the prosthesis.

Volume compensation

Once the device is fitted, the stump loses its bulk due to the disappearance of the oedema and the loss of muscle mass.
For prostheses of the tibia and knee disarticulation, the size can be made up for by wearing a stocking between the stump and the softsocket.
 
When a significant number of stockings become necessary (3-4 cotton socks) the prosthesis needs to be adjusted.
 
Since the volume of femoral prostheses cannot be padded out, the prosthesis itself must be adjusted.

Hygiene

Like any other part of the body, the stump must be washed daily.
 
As for the prosthesis, prosthetic socks must be regularly changed and washed.
The cuff can be washed in warm soapy water, rinsed in clean water and dried before being put on again (Don't use a hair drier or place on a radiator! Thermo- plastic materials may be damaged).
 
Femoral sockets may be wiped with a damp cloth (soapy water and clean water).

The use of silicone ?

Silicon and mineral-oil based materials can be used in different ways to achieve the desired effect :

In most cases it is not necessary to use silicone, although it is in fashion.

Walking aids

How long before it's possible to walk without sticks ?

Although the use of walking aids is a normal part of early rehabilitation, it is necessary to manage without them as soon as possible. It is obvious that the patient's general state of health as well as his or her age has a major influence on the length of time walking aids are required.
Some will never do without them and others don't use them at all.
There are no rules.

Using one stick ?

When walking with only one stick it is necessary to hold it on the side of the healthy leg and move it forward at the same time as the prosthesis.

Approximate measurements

"Miracle cream"

You no longer know which cream to use on your stump. Well, try not putting any on.
Often, applying cream and other unguents on the stump, especially large amounts, have a negative effect on the skin and on the cuff, which ends up becoming full of grease.
If you use a skin cream, apply it in the evening sparingly and only to the affected area before going to bed.

Jean Louis Steiner, splash pantalon

Putting on your trousers !

To put on or take off trousers without removing your shoes, put your shoes in a plastic bag. This slides more easily and prevents your trousers from getting dirty.

Eczema

In cases of allergy or eczema wrap your stump in a plastic food wrap such as Gladpack. This isolates your stump from the allergy trigger but uses only minimal thickness.
This is of course only a temporary solution.

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