The APOPPS by FLOTECH O

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The APOPPS APOPPS-TFby FLO-TECH OP
Systems, Inc.

• Robert N. Brown, Sr., CPO, FAAOP
• CEO/Research Design

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The APOPPS APOPPS-TF

• Adjustable Post-Op, Protective Preparatory
  System for Transtibial Transfemoral Amputations

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Design Goals Keep It Simple

• S-afe postop systems
• I-mmediate access
• M-odular sockets
• P-rosthetic
• Function feel
• Not One Size Fits All
• L-ook custom
• Not like Off The Shelf
• E-arly, immediate, training extended ambulation

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DELAYED HEALING

• Main cause
• Disease
• Chronic causes
• Disease
• Impact injuries
• Microscopic injuries

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The FLO-TECH-TOR

• Post-operative, protective or early fit socket
  provides
• Protection from scraping or impact injuries
• Gentle donning and doffing for easy access
  attentive wound care
• Control and prevention of flexion contractures
• Accommodation for bulbous, conical or cylindrical
  shapes
• Monitored early weight bearing shaping of the
  residuum
• Early training ambulation
• When used with a UFOS

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The VCSPS

• Variable Circumference Supra Patella Socket (PSRD
  type or Preparatory socket) provides
• Knee flexion mobility
• Gentle donning doffing for attentive wound care
• Early, training extended ambulation
• when used with the UFOS
• Early controlled shaping of the residuum
• Distal AP closure
• Accommodation for fluctuating volume
• Independence

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The UFOS

• Universal Frame Outer Socket
• Sized to fit and accept either the FLO-TECH-TOR
  or VCSPS
• Attach the Pylon and foot
• Removed in bed
• Kept in the Physical Therapy Department
• The residuum protected by continued use of the
  FLO-TECH-TOR

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The FLO-TECH-TOR-TF

• Post-operative, protective or early fit socket
  provides
• Protection from scraping or impact injuries
• Gentle donning and doffing for easy access
  attentive wound care
• Accommodation for bulbous, conical or cylindrical
  shapes
• Distal AP closure
• Monitored early weight bearing shaping of the
  residuum
• Early, training extended ambulation
• When used with a UFOS-TF

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The UFOS-TF

• Universal Frame Outer Socket
• Sized to fit the
  FLO-TECH-TOR-TF
• Attach the Knee, Pylon and foot
• Removed when the patient is in bed
• Kept in the Physical Therapy Department
• The residuum protected by continued use of the
  FLO-TECH-TOR-TF

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APOPPSTM Specifics

• Modular socket system for transtibial
  amputations, available in
• Lengths of 5 (child), 7" (youth), 7 (adult)
  9 (adult) custom
• Left and Right
• 102 standard sockets, in 11 sizes
• Circumferences 8 to 19 custom
• Sockets progress in 1 increments

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APOPPS-TF Specifics

• Modular socket system for Transfemoral
  amputations, available in
• 12" socket length custom
• Left Right
• 12 standard sockets in 3 sizes
• Circumferences 16 to 27 custom

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Selecting the Proper Length

• Transtibial Sockets
• MPT to distal end over bandages
• Transfemoral Sockets
• Ischium to distal end over bandages
• If less than 3/4 space between residuum and end
  of socket - SIZE UP
• If no stock size available - CUSTOM

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Selecting the Proper Size

• Transtibial sockets
• Approximately 1 week post-op
• Circumference 2 to 3 from the distal end
• Measure over light bandages 2 socks
• If measured over skin only, add 1
• Length MPT to distal end
• Left or Right
• Prior to amputation
• Estimated length
• Estimated distal circumference
• Add 2
• Left or Right

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Selecting the Proper Size

• Transfemoral sockets
• Approximately 1 week post-op
• Ischial Circumference
• Measure over light bandages 2 socks
• If measured over skin, add 1
• Length Ischium to distal end
• Left or Right
• Prior to amputation
• Estimated length
• Ischial circumference
• Add 2
• Left or Right

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One APOPPS?

• Three Prosthetic Programs
• 1, The FLO-TECH-TOR?
• As protective socket only
• Prevent and reduce flexion contractures
• Monitor progress with instant access to bandages
• Immediate, early or extended wear protective
  socket
• Especially good for revision surgery and to
  prevent injury

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One APOPPS?

• Three Prosthetic Programs
• 2, The Rehab System
• (FLO-TECH-TOR? UFOS?)
• Same as FLO-TECH-TOR plus
• Early and training ambulation
• When the time is right
• Usually 48 hours to 7 days after receipt of
  FLO-TECH-TOR
• Patient interactive
• Involve the patient in their rehab

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One APOPPS?

• Three Prosthetic Programs
• 3, The Preparatory System
• (VCSPS UFOS)
• Independent ambulation
• 2 weeks to 6 months post-op
• Expedite care
• The APOPPS
• (FLO-TECH-TOR?, VCSPS UFOS)

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One APOPPS-TF?

• Two Prosthetic Programs
• 1, The FLO-TECH-TOR-TF?
• Use as protective socket only
• Prevent scraping impact injuries
• Monitor progress with instant access to bandages
• Immediate, early or extended wear protective
  socket
• Especially good for revision surgery and to
  prevent injury

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One APOPPS-TF?

• Two Prosthetic Programs
• 2, The Preparatory System
• (FLO-TECH-TOR-TF UFOS-TF)
• Early or training ambulation
• Extended or independent ambulation
• (2 weeks to 6 months post-op)
• Expedite care
• The APOPPS-TF
• (FLO-TECH-TOR-TF? UFOS-TF)

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When should I use an APOPPS or APOPPS-TF

• All diagnoses ages
• In the OR
• Early postoperative (24 to 48 hours post-op)
• 1 to 3 weeks post-op (cast change)
• Any time protection or immediate, early or
  sustained ambulation, is ordered

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Early Ambulation Protocol

• Patient selection
• Competent, coherent cooperative
• except in OR
• Reasonable family or residence support
• Reasonable upper body strength

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Early Ambulation Protocol

• Apply FLO-TECH-TOR or FLO-TECH-TOR-TF
• In OR or as soon as prescribed
• Examine residuum before attempting distal
  pressure
• Tighten all straps bands before testing distal
  tolerance or attempting weight bearing
• Apply pressure to distal end (up to 10 of body
  weight) to determine readiness for weight bearing
• Examine residuum after testing distal tolerance
• Apply UFOS or UFOS-TF 48 hours to 7 days post
  application of FLO-TECH-TOR or FLO-TECH-TOR-TF
  - when the time is right.

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Early Ambulation Protocol

• Weight bearing at 10
• Tighten straps and bands prior to standing
• After weight bearing
• Examine tissue check for spotting
• Excessive or continuous - contact physician,
  minor
• Record size location and monitor
• Wash and re-apply reticulated pad
• Replace outer sock if soiled
• Reapply FLO-TECH-TOR or FLO-TECH-TOR-TF
• MPT strap - 1 to 2 fingers loose

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Early Ambulation Protocol

• Progress to 20 weight bearing
• Only after 2 days without pain or spotting
• Repeat all above daily until patient is full
  weight bearing
• Progress at 10 increments until patient
  ambulates independently and without incident

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Practitioner Survey

• In December 1998 Survey
• 13 Practitioners responded on 94 patients
• 1 Bilateral
• 95 Transtibial amputation socket fittings

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Diagnoses

• Diabetes 55 58.50
• PVD 32 34.05
• Trauma 5 5.32
• Other 2 2.13
• TOTAL 94 100.00

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Application

• Patients Room 38 40.00
• Operating Room 17 17.90
• Rehab Dept./Center 16 16.80
• Nursing Facility 9 9.47
• Recovery Room 5 5.26
• Patients Home 5 5.26
• Clinic 3 3.16
• PO Facility 2 2.15
• TOTAL SOCKETS 95 100.00

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How Was The APOPPS Used?

• 95 FLO-TECH-TOR? sockets reported
• 54 (of 95) FLO-TECH-TOR? Sockets
• For protection only 56.84
• 41 (of 95) advanced to Rehab System
• (FLO-TECH-TOR? UFOS ?) 43.16
• 100.00
• 19 Rehab advanced to Prep System
• (VCSPS? UFOS ?)
• 19 of 41 wearing 2 to 6 mos.) 46.34

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COMMENTARY

• The APOPPS provides preserves quality.
• It offers safe postoperative care (including
  ambulation) for diabetic, elderly, circulatory
  dysfunction traumatic amputees.
• It allows prosthetists to adapt the prosthesis to
  meet the rehabilitation needs of their patient in
  a gentle, yet dynamic, and cost effective manner.