New developments such as the Harmony® System have considerably increased safety and comfort, in particular for transtibial amputees. However, only if the patient receives a medical-therapeutic treatment of the residual limb directly after the amputation can the fitting be truly optimized and possible complications prevented.
In fact, preventive care already begins with the surgery, where the residual limb is to be shaped with regard to functionality. For example, bone protrusions are padded with muscle tissue so that they do not lie directly beneath the sensitive skin. In each phase of residual limb fitting, the treatment considers and adapts to the cause of the amputation, the particularities of the residual limb as well as individual risk factors. During the post-operative wound healing phase, treatment focuses on wound care and cautious residual limb shaping. Wounds must be checked daily and in particular for infections and blood coagulation. Due to the size of the wound, post-operative edemas—an accumulation of tissue fluid between the cell layers—often develop. A targeted edema treatment using compression therapy involves classic compression bandages, Unna’s boot, a residual limb cast and, after removing the wound draina ges, post-operative liners. Daily lymph drainage and proper positioning of the residual limb above the heart level furthermore accelerate healing. During edema therapy and residual limb shaping, a strangulation of the residual limb must be strictly avoided as severe complications may result otherwise.
Once the wound has healed, the treatment will focus on promoting a differentiated sensory capacity as well as a skin induration of the residual limb. At the same time, the adjacent joints are mobilized to maintain or regain the patient’s natural range of motion. The residual limb muscles then have to be trained such that the prosthesis can be worn and used securely. A prosthesis should be fitted as soon as the residual limb has been sufficiently treated and prepared. Patients begin by wearing the prosthesis for shorter periods of time, slowly building up to extended time frames in order to allow the skin and tissues to adapt to the mechanic device. Active participation of the patient is of utmost importance. After all, patients know and feel the particularities of their residual limb better than anyone else. Patients can contribute by adopting lifestyle changes, such as stopping to smoke or optimizing blood sugar levels through diet. Residual limb exercises, weight training and whole-body exercises are further activities that are highly recommended. Moreover, patients must learn to tend to their daily residual limb care. Experienced physio-, occupational and sports therapist as well as gait and walking
teachers should be consulted.
Otto Bock’s Harmony® System features an innovative concept for bedding residual limbs. The new concept tops conventional procedures and is also effective with more difficult medical problems. Distinguished with the “Life Science Award ‘Concepts’” in October 2005 (photo), the Harmony® System offers advantages for lower limb amputations and associated blood flow problems. The Harmony® System is an optimal fitting in particular for patients with diabetes, arterial occlusive disease or residual limb complications due to bony structures directly under the skin or scar irritations. The socket is custom-shaped to protect sensitive structures. Full contact between liner and socket provides optimal adhesion. The residual limb is thus effectively protected from chafing or pressure sores. Negative pressure promotes blood circulation in even the smallest vessels. This prevents the unwanted decrease of the residual limb vo lume that generally occurs when the prosthesis is worn for a longer period of time. The good fit remains in place throughout the entire day. When taking the prosthesis off, the residual limb is warm and has an evenly distributed blood supply. Finally, the Harmony® System has a suspension that protects the joints.
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