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Walter Racette C.P.O.Associate Clinical Professor

Director, Orthotic and ProstheticCenters@ UCSF

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When?

All reasonableattempts to fit the

socket, align, andsuspend have beentaken. This shouldinclude necessary

design changes andcomponents

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Much higher rate ofrevisions after traumaticamputation or failedlimb salvage

Often overlookedsolution by prosthetist.Patients go fromprosthetist toprosthetist. $$$$$$

Ask your patient whenwas the last time theyhad an x-ray

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When?

Potential change couldsignificantly improve

the function for thepatient

There is evidence;physical exam, x-ray

etc that indicateprobability ofunderlying issues

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As in the case oftrauma, revision ofthe residual limb is

necessary as it was ofsecondary importanceat the time of theinitial amputation;other life threateninginjury and or infection

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WHY?

The socket/skininterface is a critical

element forsuccessful full timeuse for an upper orlower extremity

amputation

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WHY?

Successful use of theprosthesis on a full timebasis requires a pain

free socket. Factors that affect

socket fit

1. Alignment

2. Suspension3. Inappropriate use of

interface; sockmanagement

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Although the upperextremity amputeeneed not weight bear

there are just as mayreasons that thispatient populationcan benefit from

revision surgery IFnot more.

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Issues to considerbefore revisionsurgery

Residual limb lengthbefore/after

Initial reason foramputation

Patient age Patient

desire/motivation

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Soft tissue issues

1. Scaring andadhesions

2. Redundant tissue3. Neuromas

4. Phantom limbpain/sensation????

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Scaring andadhesions; why doesit present such a big

problem for thesocket/skin interface?

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Redundant tissue:Isnt good skincoverage over bone a

good thing?

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Neuromas: Every cut

end of the nervedevelops one; whyand when do theybecome a problem?

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Bone/residual limblength

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Examples of bone

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After exhausting all prosthetic options

After evaluation of patient utilization andpotential

After determining clinical evidence useful inpredicting improvement

Revision surgery can greatly improve the fit and

function of a prosthesis and lead to a higherfunctional level for the patient. It is often adelayed or forgotten avenue of total treatment.