In this episode of The O&P Check-in: an SPS Podcast, we spoke with Jim Reichmann, MBA, MPH, about the evidence surrounding amputee postoperative care. Jim has a Master of Public Health and has published on amputee postoperative care in the Journal of Vascular Nursing, PM&R Journal, and Current Physical Medicine and Rehabilitation Reports. He has also served on a Technical Expert Panel for the Agency for Healthcare Research and Quality, worked with the U.S. Food and Drug Administration to discontinue the use of dangerous drugs in pregnancy, and contributed to various evidence-based guidelines for payers.
The following includes an excerpt from our conversation, edited for length and clarity. Click here to listen to the full interview.
The O&P Check-in: an SPS Podcast unpacks trends and stories from the tight-knit community of O&P professionals. From patient care to technology, best practices, and regulations, this podcast features topics that help you stay current.
In your opinion, what are the essential components of an effective postoperative program for those who have experienced limb loss?
When it comes to postoperative amputee care, I talk about healing the head, the heart, and the residual limb. And I think you must get all three of those components for a complete healing process for the amputee.
Four things affect the outcome of amputees:
- Surgical technique
- Postoperative dressing and support system
- Site of discharge
- Intensity and duration of physical therapy
The prosthetist has a tremendous influence over the dressing choice and the provision of peer support, two very important components in postoperative healing.
For those who may be unfamiliar, what are removable rigid dressings (RRDs), and what are the benefits according to your research?
There are four available dressing choices postoperatively for the transtibial amputee: the soft dressing, which is normally paired with a knee immobilizer, hard cast, weight-bearing, IPOP, or immediate postoperative prosthesis, and removable rigid dressing. 85% of patients receive a soft dressing and a knee immobilizer and 14% of patients receive a removable rigid dressing.
Removable rigid dressings include the FLO-TECH device, Limbguard, and even individually fabricated devices. These dressings have a hard surface that provides the same benefits as a hard, rigid cast. They can also be easily donned and doffed to inspect the residual limb and the surgical wound frequently.
I'm device agnostic, so I don't really care what removable rigid dressing people use. However, the discussion should focus on elastic bandages and knee immobilizers, which make up about 84-85% of the market, compared to removal rigid dressings, which have the second largest market share, about 14-15% of the available dressings.
In 2018, I did an extensive review on removable rigid dressings in PM&R Journal. It showed RDDs helped promote faster healing, reduced edema, assisted in limb contouring, prevented knee flexion contractures, and protected the residual limb from damage due to falls.
In that review, there were 16 studies, and that was all the evidence on removable rigid dressings at the time. There are now 20 studies, and there have been four since 2020, all of which showed a benefit to an RRD versus an elastic bandage. It begs the question, why don't people use this?
When I surveyed users of removable rigid dressings and asked them why they used them, they universally came up with the exact same initial response: to protect the residual limb from falls because of the high fall rate they had observed in this population.
To hear the entire conversation, click here:
