Orthoflex Splints in the Treatment of Wounds of the Foot, Ankle, and Leg and the Prevention and Treatment of Pressure Sores of the Foot.

Wound Treatment:

Introduction:

Chronic wounds of the foot, ankle, and leg are commonly caused by neuropathy (often diabetic), pressure sores, ischaemia, or varicose ulcers. Their treatment requires patience and daily perseverance and often needs a long time. Medical teams treating these difficult cases and the patients themselves often feel frustrated by the work intensive, unrewarding, never ending, and repetitive wound care process.
Therefore any system of wound care which makes for efficient wound protection and rapid convenient change of dressings whilst allowing limb function to continue is to be recommended.

The Orthoflex splint method for wound treatment:

The splint is inflated sufficiently to provide a firm sole support for the anatomical
plantigrade position of the foot and ankle to prevent heel cord contracture. However the body of the splint should remain soft and pliable and must not be inflated to rigidity. The special inner upholstery pad protects the heel from any contact pressure.
A secretion absorbing nappy sheet is always placed in the splint prior to the placement of the limb into the splint. This is an essential extra item when treating wounds in the Orthoflex splint. The nappy sheet has a soft absorbing cotton wool-like surface facing and wrapping the limb whilst its splint facing surface is impermeable to secretions. If the sheet becomes soiled it is exchanged at each change of dressings.

The wound dressing itself need not be bulky: sterile dry or fatty gauze covered by a single pad is enough, since the absorptive nappy sheet is all that is needed for padding and secretion absorption. The straps are then tightened as needed and the patient can ambulate in the splint at home or in the hospital ward. No additional padding is needed since the nappy sheet pads the foot, ankle and leg as well as padding the skin under the straps. Since the splint is not inflated to rigidity, foot and ankle movement can take place if this does not disturb wound healing. When treating varicose ulcers the long splint is needed: otherwise then short splint is suited for foot and ankle wounds.
Post operative wounds after elective or urgent foot and ankle surgery are cared for in exactly the same manner.

If the splint is soiled it can be re-used for the same patient by scrubbing it with chlorhexidine soap solution or laundering in a washing machine at 30 degrees Celsius.
In my experience, patient and staff satisfaction and compliance were much improved by using the Orthoflex method. Time saving was significant and the savings on expensive wound dressing materials far outweighed the expense of the cheap nappy sheet changes.

Pressure Sores:

These are wounds caused by prolonged pressure on the skin: the blood supply to the skin is cut off by the pressure and the skin dies. Various specific anatomical sites are prone to develop pressure sores: especially where there is pressure during lying or sitting on skin that lies directly over a bony prominence: the heel, the borders of the feet, the ischial tuberosities, the sacrum, the trochanters, the elbows, the points of the shoulders. In the immobile patient a pressure sore may develop at any one of these points irreversibly within 3-4 hours: the skin cannot live for longer deprived of its blood supply. Such pressure sores are liable to develop severe infections in the dead skin and sub-cutaneous soft tissues.

Who is at risk?

The acute immobile patient who cannot move: he may be an unconscious patient in the intensive care unit, a paralyzed patient, or a patient after surgery confined to bed.
The chronically immobile disabled patient who has lost his independence and cannot move himself (home care, geriatric institutions, disabled recumbent nursing care).
The diabetic patient who has lost the feeling in his feet and other causes of sensory neuropathy.

Principles of Pressure Sore Prevention:

Padded protective support to the foot and ankle preventing any pressure on the heel
and preventing heel cord contracture—such as by use of the Orthoflex splint.

Prevention is the task of utmost importance. By the unfailing implementation of the principles of prevention, pressure sores can be avoided, even during long term immobility. A pressure sore is caused rapidly within a few hours: its treatment is long and work intensive and often fails.

• Change of position every two hours whether lying or sitting.
• Special pressure point changing mattresses, beds, and wheel chairs.
• Daily pedantic foot hygiene.
• Creaming or oiling to prevent skin cracks.
• Daily inspection of the anatomical sites prone to develop pressure sores.

Principles of Pressure Sore Treatment:

Once a sore is present the principals of prevention continue to be paramount in the management of treatment in order to prevent the enlargement of the sore, pressure on the existing sore or the recurrence of the sore after successful treatment
The local treatment is by daily cleansing, change of dressings, excision of necrotic tissue and skin grafting when indicated (and occasionally in the severest septic cases—amputation). After bacterial culture of the wound secretions, specific antibiotics are administered.
Concomitant with the treatment the Orthoflex Splint provides the required protection, support, and pressure prevention.

The Unique Properties of the Orthoflex Splint:

User friendly: rapid, time saving, simple application and removal by one pair of hands resulting in excellent staff compliance.

• Preventing any pressure on the heel, and heel cord contracture.
• Non-circumferential: easy inspection of the limb.
• Variable stiffness as required by the treating physician: flexibility allows movement
• To prevent stiffness and facilitate rehabilitation.
• Fit over DVT prevention sleeves in intensive care.
• Easily tightened or loosened in response to swelling or shrinking of the limb.
• Radiograph translucent.
• Washable and disinfectable using standard solutions such as hexachlorophene or chlorhexidine soap solution except for the inner padding which is disposable for single use only.
• Wound secretions are absorbed by standard bed disposable bed nappies placed into the splint when treating open sores.
• In collapsed state storage requires minimal space.

Prof. Daniel Reis
www.orthoflex.net