presented by John Fergason
Proper early care of the patient who has sustained lower limb amputation is critical for obtaining successful functional outcomes once fitting and ambulation with a prosthesis have begun. This course will present the current status of amputation etiology, incidence, and prevalence in the United States. Following this framework, a method of limb care and preparation will be presented as well as several treatment options that can be applied to the individual rehabilitation needs and prognosis of the patient.
John Fergason, CPO, is the Chief Prosthetist at the Center for the Intrepid at San Antonio Military Medical Center. He was formerly an Instructor and Clinical Manager for the Prosthetics-Orthotics Program at UT Southwestern in Dallas, TX and proceeded to become the Director of the Division of Prosthetics-Orthotics at the University of Washington in Seattle, WA. He currently is adjunct faculty for the Baylor Prosthetics-Orthotics Program and the UT Southwestern Prosthetics-Orthotics Program. He has lectured extensively on all topics in lower limb prosthetics, has many peer-reviewed articles and has authored multiple book chapters. While at Brooke Army Medical Center, he has developed the services from a small laboratory serving the local needs of the hospital to an international Center aimed at improving function for service members who have sustained catastrophic limb injury. His staff continues to treat the most complex patients seen as a result of battlefield injury and has become established as one of the primary military centers for limb loss.
An understanding of the current amputation status in our country is paramount in understanding the rehabilitation needs and challenges for this population. The causes and associated complications of amputation will be used to prepare an appropriate treatment plan.
A post-operative care plan should be established prior to the surgical procedure. This will determine when your intervention will begin. It can begin as soon as in the operating room upon wound closure, in the recovery room, or later in the recovery process.
This chapter progresses into the post-acute phase of treatment that will most often occur as an outpatient. Protection of the residual limb continues to be important as preparation begins for the first fitting. Typical weight bearing regions of both the transtibial and transfemoral residual limbs are discussed while particular attention is paid to how these regions can be assessed and prepared for weight bearing in the prosthetic socket.
This chapter continues the examination into the post-acute phase of treatment that will most often occur as an outpatient. The importance of assessing skin grafts and limb shape before fitting for a prosthesis is covered. A patient’s candidacy for a prosthesis will also be discussed, including the benefits of certain types of prostheses for different patients you may encounter.