2010-05-04
Immediate postoperative prosthesis (IPOP) utilisation in septic and tumour amputees in a government hospital
Immediate postoperative prosthesis
(IPOP) utilisation in septic and tumour amputees in a government hospital
Abstract
Rapid rehabilitation of lower limb amputees has far-reaching psychological and economic implications. Postamputation regimens commonly involve the application of a dressing and light compression bandage while awaiting wound healing. This is followed by the application of a coning bandage to facilitate stump reduction, and thereafter fitment of a primary prosthesis. This process commonly takes 17 weeks in transfemoral amputees and 11 weeks in transtibial amputees.
A prospective study of 25 amputees (15 males and 10 females) who underwent the application of an immediate postoperative prosthesis (IPOP) was conducted. Utilising this technique, rehabilitation and prosthetic application commence immediately postoperatively within the operating theatre, and run in tandem with stump healing.
Mobilisation with crutches or a walker on a temporary prosthesis was achieved within five days for both transtibial and transfemoral amputees, and crutch-assisted mobilisation on a primary prosthesis was attained within four and five weeks respectively. This was attributable to a relative preservation of stump size, muscle strength and cardiovascular fitness, minimisation of contracture development, as well as apparent psychological benefits to the amputees, many of whom were children. The IPOP technique was found to reliably accelerate the rehabilitation of tumour and septic amputees at the Johannesburg Hospital tumour and sepsis unit.
Conclusion
The results of our small study are encouraging and indicate that the use of an IPOP may be a safe and reliable technique to facilitate rapid ambulation post-amputation. There were definite physical and, although we did not specifically test for it, apparent psychological benefits, to patients requiring amputations for musculoskeletal malignancy or infection.
| 
