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Sep 04

Removeable Rigid Dressings

I am wanting to ask a few questions to the physios who work in acute setting with amputees.

We have been applying RRD’s to our BKA’s once the drain is out as this is all our surgeons would agree to. We always had quite a bit of resistance from our surgeon. We have been only applying RRD’s to the wounds that look quite good and aren’t oozing much. We have just been getting the nursing staff to apply Melolite or some very thin dressing and then applying the RRD over the top of that. However, we have had a couple of new vascular surgeons come on board and they are now keen to get RRD’s on asap after amputation.

Now that the surgeons are wanting the RRD’s applied within 2 hours post-op, I’m not sure what dressings are appropriate. I was called to apply an RRD today to a patient who had just come out of recovery. He had a little corrugated ‘yaetes’ drain insitu which was draining opening into green gauze and Melolite dressings with combines over the top and then webril and crepe bandages over the top of that. There was a lot of blood, which was bleeding through the combines. I didn’t do an RRD as the nurse CNC and I weren’t sure if it were appropriate with all of this bleeding and with such thick dressings.

Here are my questions:

  1. Do other sites apply RRD’s intra-op or within a few hours post-op? Or are other sites mostly applying RRD’s when the drain is removed?
  2. Intra-operatively, do surgeons apply rigid dressings or RRD’s at any sites? Or do the physios always go into theatre to apply them?
  3. What types of drains do your surgeons use? Open corrugated ones that bleed into the dressings or more of a Bellovac type that drains into the plastic container at the end?
  4. What type of dressings are applied to your amputees’ wounds post-operatively? Closed ones that stop the blood from oozing everywhere?
  5. Are RRD’s ever indicated for AKA’s? We have had a couple of requests for AKA RRD’s.
  6. Do any sites have any specific guidelines or business rules for rigid dressings apart from the ‘NSW Health Guideline, Amputee Care – The use of post-operative rigid dressings for trans-tibial amputees’.

I would really appreciate your advice and thoughts on these issues.

Thanks so much,

Kate Weeks
Senior Physiotherapist- OACCP Musculoskeletal Co-Ordinator and Senior Surgical Physiotherapist,
Wollongong Hospital

2 comments

  1. Kristen O'Connor

    Hi Kate,

    I cannot respond to most of your questions as I work on Inpatient Rehabilitation in a regional area and the majority of our amputee patients are transferred to us from metropolitan centres once ready for rehab. We apply our RRDs on admission to our facility if not already fitted and this means that we don’t have to deal with drains. Our RRDs are mainly used as a form of protection like a ‘helmet’ rather than providing active compression.

    In response to Question 5, our AKA’s don’t get RRDs as it is difficult to suspend and fit appopriately. The only AKAs that have received helmets on our site had very long residual stumps that allowed a good fit and suspension mechanism and the patients were high risk falls.

    We will often use modified shrinkers or silicone liners for oedema management in AKA patients once wound ready.

    Kristen O’Connor | Physiotherapist

    Inpatient Amps/Ortho Rehabilitation
    Anne Caudle Centre
    Bendigo Health

  2. Mary-Clare Tremain

    Hi Kate

    I work at a limb centre in new Zealand and the adjacent hospital use RRD’s applied in theatre by the Vascular surgeons / registrars. WE use the shape mate version of RRD. There have been some issues with knowledge and skill and change in product but the ward physio spends time teaching the new registrars and we have problems solved the new product changes.

    The below document has the older instructions for applying RRD and a picture of the drain used and dressing.

    https://docs.google.com/gview?url=http://nzals.govt.nz//assets/Resources/Amputee-care/Amputee-care-guidelines/DebbieHockleyCareGuidelinesReport.pdf&pli=1

    the differences about using the new product are mainly around the preparation of the shapemate product.

    I have not applied or seen an AKA RRD. i have been asked to make one as the person was ‘not made one in theatre’ however i feel that due to the size of an AKA stump our product is not suitable, the position of the thighs together would render this to be uncomfortable and have potential risk to damage the intact limb / inner thigh. AS per Kirsten’s reply we use shrinkers when the would is ready.

    Mary-Clare Tremain | Physiotherapist
    Hamilton Limb Centre
    New Zealand Artificial Limb Service

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