Combating Post Surgical Swelling

Combating Post Surgical Swelling
Thomas Rambacher D.P.M.
Associate APWCA
Special Thanks to Laura Jacobs MD and Susan Rajotte RN
Thomas Rambacher - Who is he?
BS and MAT from Marshall University
D.P.M. from Ohio Collage of Podiatric Medicine
PPMR from The Cleveland Clinic Foundation
PSR-12 Saddleback Surgical Residency
Program
3 years+ private practice in Orange County
California
Current Assistant Residency Director at
Saddleback Surgical Residency Program.
Current Treatment for post-op swelling
Elevation
Ice Therapy
Static Dressings (Ace, Co-flex)
Compressive Dressings (Jones dressing)
Anti-Inflammatory (NSAIDS)
Diuretics (Lasix)
Total Non-Weight Bearing
Incubation of Idea
I have tried most of
available treatment except
total non-weight bearing.
California’s active lifestyle
pressures a speedy return
to pain-free activity.
If Norma Tec's PCD can
reduce swelling in wounds
and lymphedema,
Why Not in Surgery!
My Treatment Motto,
Listed on web site: to
“offer patients a return
to an active lifestyle
after treatment or
surgery.”
California’s Life Style?
Patient Trial of 5
All comers taken in December of 2005
3 pneumatic compression devices (PCD)
applied at time of surgery
2 pneumatic compression devices applied in
post-operative period
No ice or anti-inflammatory uses in post-op
period with PCD.
Patient 1 GJ
Bilateral surgery for Plantarfibromas,
Hammertoes and Bunion
Compression started in recovery room
Settings 70,70,60,60,50, R30
Time: (35 days total)
–
–
–
3-4 hours a day 7 days
2-3 hours a day 7 days
1 hour a day 21 days
Patient 1 GJ
Pt had decreased narcotic usage
Pt has zero days immobile
Pt reports no pain with application of PCD
Pt went on a one-week trip to Mexico (CSL) 3
weeks post-op
Pt thank-you note
Patient 2 WH
Surgery for Hammertoes and Bunion
Compression started in recovery room
Settings 70,70,60,60,50, R30
Time: (21 days total)
–
–
1-2 hours a day 7 days
1 hours a day 14 days
Patient 2 WH
Pt had zero narcotic usage
Pt has zero days immobile
Pt reports no pain with application of PCD
Pt returned to work on 3rd post-op day
Patient 2 WH
Radiographies taken on 21st day post-op
Patient 3 FL
Surgery for Ganglion and Midfoot Exostosis
Compression started in recovery room
Settings 70,70,60,60,50, R30
Time: ( 13 days total)
–
–
–
1 hour a day 7 days
Non-compliance for 6 days
1 hour a day 6 days
Patient 3 FL
Pt had decreased narcotic usage first 7 days
Pt has zero days immobile
Pt reports minimal pain with application of PCD
No swelling and minimal bruising at post-op day 7
Pt went to casino’s New Year’s Eve celebration and
discontinued post-op treatment for a week
Wound dehiscence and post-op infection noted on
14th day post op
Patient 4 SP
Surgery for Ankle Arthroscopy
Compression started 4 days post op
Settings:
–
–
–
70,70,60,60,50, R30
60,60,60,60,50, R30
60,60,50,50,40, R30
Time: (4 days total)
–
–
1 hours a day 3 days
0.5 hours a day 1 days
Patient 4 SP
Pt had normal narcotic usage
Pt has 6 days immobile, limited mobility for 3
weeks
Pt reports pain with application of PCD
Substantial swelling post op, pre application
Pt history of radiculopathy and Complex
Regional Pain Syndrome (RSD), pitting edema
Switched to Ice and NSAID Protocol on
Post-Surgical day 8
Patient 5 MD
Surgery for Plantar Ulcer, Hammertoes, Bunion
and IPJ Fusion
Compression started 26 days Post-op
Settings 70,70,60,60,50, R30
Time: (14 days total)
–
0.75 hours a day 14 days
Patient 5 MD
Pt had increased narcotic usage
Pt has 14 days immobile
Pt reports no pain with application of PCD
Wound V.A.C. applied at time of surgery until
day 26
Nurse assisted application of PCD
Pt history of painful neuropathy, five-year open
ulceration and pitting edema
Patient 5 MD
Pre compression
Post compression
PCD Conclusions, for Post-Op Group
Early application of PCD diminished swelling cascade
in my trial group
Application of PCD is generally not painful to patients
Application over internal fixation and orthopedic
procedures had no ill effects in trial group.
PCD Conclusions, for Post-Op Group
Patients had an overall decrease in postoperative swelling, decrease in narcotic usage
and a more speedy return to active time versus
traditional post-operative protocol.
Objective multi-center study may show
Pneumatic Compression Devices as the next
evolution of post operative care.
PCD Conclusions, for Post-Op Group
Questions?
Thomas Rambacher 949-637-003