Wound management and early prosthetic rehabilitation

对于残肢患者来说，残肢与关节窝之间的接口是假肢系统中最复杂但也是最重要的部分之一，可以实现康复后生活质量的潜在改善。这个插座/身体接口在用户舒适和控制假体以恢复活动能力方面起着重要作用。对于软组织尚未适应假肢使用的初级截肢者来说尤其如此，并且在术后治疗和康复中可用的替代方案通常基于低质量的证据。因此，伤口愈合，其管理和软组织健康总体上对于加快康复过程和增加结果潜力至关重要，因此是本提案的主要推动力。目前的临床实践主要依赖于“动手”铸造，其中假肢窝是单独设计的。在残肢上手工涂抹巴黎石膏包塑，以获得残肢独特的修改形状。这种形状被用来产生一个正模型，并根据几种设计范式之一在形状上进一步转换。这些程序是高度不一致的，并且基于隐性知识——单个义肢师的表现将受到个人经验、技能和信仰的强烈影响。当关节窝设计过程不一致时，这将导致关节窝相对于假肢足定位的挑战，以确保接近正常的行走。这个过程被称为“对齐”。这些困难在总体上损害了假肢康复，并阻碍了以证据为基础的插座匹配标准的发展和建立。建议的工作将利用实际操作和不干预的形状捕获技术。在后一种铸造过程中，将未固化的编织、碳基、玻璃基或天然纤维基材料涂在渣滓上，

For the population who are affected by limb loss, the interface between the socket and residual limb is one of the most complex but important parts of a prosthetic system to realise the potential quality of life improvements of rehabilitation. This socket/body interface plays a fundamental role in the user's comfort and control of the prosthesis to regain mobility. This is especially true for primary amputees where the soft tissue has not yet been conditioned for prosthetic use and the available alternatives in postoperative treatment and rehabilitation are often based on low quality evidence, Therefore, wound healing its management and soft tissue health in general, are essential to speed up the rehabilitation process and increase the outcome potential and is therefore the main driver for this proposal.Present clinical practice relies mainly on "hands-on" casting where prosthetic sockets are individually designed. A Plaster of Paris wrap cast is manually applied over the residual limb to capture the unique modified shape of the limb. This shape is used to produce a positive model and this is further transformed in shape according to one of several design paradigms. These procedures are highly inconsistent and based on tacit knowledge - performance by an individual prosthetist will be strongly influenced by personal experience, skill, and beliefs,6. When the socket design process is not consistent this results in challenges for positioning of the socket relative to the prosthetic foot, to ensure near-normal ambulation. This process is referred to as "alignment". These difficulties compromise prosthetic rehabilitation in general and hinder the development and establishment of evidence-based socket fit criteriaThe proposed work will utilise both hands-on and hands-off shape capturing techniques. During the latter casting procedure, uncured braided , carbon -, glass -, or natural fibre based, materials are applied over the residuum,