U.S. patent number 3,889,301 [Application Number 05/467,095] was granted by the patent office on 1975-06-17 for therapeutic stump treating air sac prosthesis.
This patent grant is currently assigned to Marion K. Bonner. Invention is credited to Francis J. Bonner, Sr..
United States Patent |
3,889,301 |
Bonner, Sr. |
June 17, 1975 |
Therapeutic stump treating air sac prosthesis
Abstract
A prosthesis is provided in which an amputative leg stump is
surrounded by an air sac surrounded by a casing which confines the
pressure of the air sac inwardly against the stump. Means are
provided for supporting the distal end of the air sac around and
beneath the patient's stump. Protuberances are provided between the
air sac and the casing, distorting the surface of the air sac and
giving it vertical stability with respect to the supporting
means.
Inventors: |
Bonner, Sr.; Francis J.
(Ardmore, PA) |
Assignee: |
Bonner; Marion K. (Ardmore,
PA)
|
Family
ID: |
23854318 |
Appl.
No.: |
05/467,095 |
Filed: |
May 6, 1974 |
Current U.S.
Class: |
623/37;
623/38 |
Current CPC
Class: |
A61F
2/7843 (20130101); A61F 2/80 (20130101); A61F
2002/6614 (20130101); A61F 2/601 (20130101); A61F
2002/607 (20130101); A61F 2002/5081 (20130101) |
Current International
Class: |
A61F
2/50 (20060101); A61F 2/80 (20060101); A61F
2/78 (20060101); A61F 2/60 (20060101); A61F
2/66 (20060101); A61f 001/12 (); A61f 001/08 () |
Field of
Search: |
;3/20,17-19,21,2 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
Primary Examiner: Frinks; Ronald L.
Claims
The following is claimed:
1. In a prosthetic device for therapeutic treatment of an
amputative stump, the combination which comprises means providing
an air sac shaped for arrangement in intimate contact with the
sides and bottom of the amputative stump, said air sac being
essentially empty except for said air, and being internally open
and unimpeded with respect to flow of air from place to place
within said sac, means for introducing air into said sac for
maintenance of said air under pressure therein, said air sac having
an internal and an external side wall which are shaped downwardly
and inwardly in a manner to provide an air space which is adapted
to wrap substantially around the distal end of the stump, means for
providing a substantially rigid casing surrounding and confining
said air sac, and supporting means for said casing, wherein said
air sac has a sealed distal end adapted to be located in the area
of the distal end of the amputative stump, and wherein a
shock-absorbing resilient supporting means is provided extending
under and in contact with said distal end of said air sac, and
arranged to exert a force against said distal end in a direction to
urge it upwardly toward and against said distal end of said
stump.
2. The prosthetic device defined in claim 1, wherein said
supporting means includes a plurality of straps extending across
the prosthetic device.
3. The prosthetic device defined in claim 1, wherein said sealed
end is annular.
Description
BRIEF DESCRIPTION OF THE INVENTION
This invention relates to a prosthetic device for an amputative
limb, particularly, an amputative leg stump. It relates
particularly to the provision of a prosthetic device which may be
used immediately in the post operative phase following surgical
amputation.
BRIEF DESCRIPTION OF THE PRIOR ART
In recent years, many advantages have been obtained by the use of a
temporary prosthetic fitting in the rehabilitation of patients in
the immediate post operative period. However, known techniques such
as the use of rigid plastic sockets and the like have resulted in
severe pain, stump damage and various other difficulties, all of
which severely interfere with the physical and mental recovery of
the patient from the trauma of the amputation procedure.
Various devices have been created in an effort to bring about early
ambulation, overcome problems such as stump damage, collection of
edema in the area, and pain and discomfort to the patient during
the period of use of the prosthetic device. For example, J. M.
Little, in Med. J. Aust. 1972, 1:1300-1302 describes the
combination of a rigid frame with a pneumatic prosthesis, which is
described as being useful in connection with lower-limb prosthesis,
and which is capable of modification for use by above-knee
amputees. In such case a webbing harness is provided, running over
the patient's shoulders and attached to the metal frame of the
prosthesis.
It has been my experience, however, with prosthesis of this type,
that serious difficulties have been encountered in actual use. For
example, I have found that when the distal end of the stump is
unsupported a "mushrooming" effect occurs in which edema collects
at the distal end, with resulting extreme discomfort to the
patient, and with interference with the orderly procedure of the
rehabilitation process. Further, the air sac has been subject to
accidental deflation by contact with sharp objects, cigarettes or
the like, with near-catastrophic results with respect to the
post-operative stump. All of these factors have tended toward
enforced bed rest during the immediate post-operative period.
Post-operative edema is a serious problem which almost always
occurs after amputation. Further, the trauma afforded to the
extremity by surgery causes a subsequent stasis of blood in veins
and capillaries, and tends to create a clotting situation in the
veins which is referred to as phlebothrombosis. This is a serious
condition and may have serious consequences; the clot may break
loose and pass on to the heart or to the lung causing a pulmonary
infarct, which may result in sudden death. Further, if clotting
remains in veins in the post amputative area, the clots seriously
interfere with the return circulation of the body fluids of the
stump to the heart, thus producing a condition of edema with venous
insufficiency. Should the clotting occur in the arteries of the
stump, then a condition of vascular arterial insufficiency occurs,
which results in an inadequate blood supply to the stump, with
resultant poor healing or failure to heal. This may cause a
gangrenous condition of the stump, sometimes requiring
re-amputation at a higher level. This possibility subjects the
patient to double jeopardy with respect to his life, and to the
trauma of the subsequent amputation.
Other complications, in addition to the failure to obtain rapid and
proper healing of the incision, include the lack of absorbtion of
the extra vasated blood and other waste materials which necessarily
follow surgery and are not removed by a surgical drain or the like.
Still another complication is the development of contracture of the
joint above the situs of the amputation, due to a lack of immediate
mobility of the stump.
Other complications that may occur when there is lack of immediate
mobility of the stump include decreased metabolism, development of
thrombotic phenomenon in the extremity which has not been operated
upon, as well as in the stump, with resultant jeopardy of limb and
life, respiratory problems, possible development of decubitus
ulcers due to the pressure of the body against bony prominences --
further complicating the rehabilitation of the patient, and various
psychological effects.
Among the sequelae may be mentioned the organization of
extravasated blood into dense, fibrous connective tissue resulting
in hard tumorous masses which interfere with the fitting of a
permanent prosthesis, even after several weeks or months of healing
time. These fibrous collections are frequently painful in
themselves and also cause pain by exerting pressure on adjoining
structures such as nerves, bones, etc. This may further jeopardize
the patient by subjecting him to further surgical intervention.
Further, the development of smaller fibrous whorls results in pain
to the patient and may result in inadequate circulation.
It is, of course, of critiical importance that the post-amputative
healing must be such as to produce a stump that is pain free so
that it may be fitted for permanent prosthesis. Many of the
post-amputative patients are quite elderly, or quite ill, and are
so weak that they cannot walk with one leg and with crutches after
amputation. The supplemental support of a lightweight, temporary
prosthesis, on which the patient can bear weight, can make a
critical difference between ambulation or bed-chair confinement,
with all attendant complications. It is especially important to
provide a prosthesis which is light enough in weight to permit
weakened patients to ambulate.
OBJECTS OF THE INVENTION
It is accordingly an object of this invention to provide a
temporary prosthetic device, usable in connection with
post-amputative patients, which not only eases the rehabilitation
procedure but also provides beneficial manipulation of the
post-amputative member.
Another object is to provide a temporary prosthesis which may be
used by weakened patients in the immediate post-operative period
and which significantly contributes to post-amputative healing.
A further object of this invention is to provide such a device
which is strong, lightweight, inexpensive, easy to use and which is
readily adaptable to various lengths, sizes, types and
configurations of amputative stumps.
Still another object of this invention is to provide such a device
which is easily applied and removed, making it possible to inspect
the stump at any time.
Other objects and advantages of this invention will further become
apparent hereinafter, and in the drawings.
DRAWINGS
Of the drawings, FIG. 1 is a view in section, showing one
particular form of prosthetic device embodying features of this
invention, and
FIG. 2 is a sectional view taken as indicated by the lines and
arrows II--II which appear in FIG. 1.
DETAILED DESCRIPTION OF THE INVENTION
Although the following description will employ specific terms for
the sake of clarity and for convenience in referring to the
specific embodiment of the invention selected for illustration in
the drawings, it will be appreciated that these terms, and the
specific form illustrated in the drawings, are not intended to
limit the scope of the invention, which is defined in the appended
claims.
Referring to FIG. 1, the letter S designates the post-amputative
stump, which is surrounded as shown in the drawings, by an air sac
10 which has an inner wall 11 and an outer wall 12. The casing 13,
of fiberglass or the like, is shown as being reinforced by vertical
internal ribs 14 and by rings 15 which may be circular in shape as
shown in FIG. 2.
The number 16 designates straps, secured to the casing 13, and
suspended across beneath the distal end of the air sac 10,
immediately beneath such distal end. Accordingly, the straps 16
form a web extending in several directions across the prosthetic
device, immediately beneath the end of the patient's stump and the
lower ends of the air sac 10.
The ribs 14 curve inwardly at 20 and converge to join with a
support 17, which is connected slidably and telescopically to
another support 18 which in turn is affixed to a solid ankle
cushion heel type foot 21. The foot 21 is also sometimes referred
to as an "SACH" foot, as is well known in the art. The number 22
designates an adjustment screw device, conveniently arranged for
adjusting the length of the prosthetic device, and for adjusting
the direction of the foot.
It is important in accordance with this invention that the air sac
10 is substantially completely surrounded, as shown in FIG. 2, by
the rigid casing 13. The casing 13 rigidly confines the outermost
portions of the air sac 10, preventing them from yielding
outwardly, or "ballooning" in a manner to impede the effectiveness
of the air sac in maintaining, supporting and centering the stump S
in position with respect to the supporting structure of the
prosthetic device.
It is also important in accordance with this invention that a
plurality of rings or protuberances 23 are provided, shown in the
drawing as rings running in a complete circle around the inside of
the casing 13, such rings being spaced apart from each other
longitudinally with respect to the prosthetic device. As will be
observed from the drawings, these protuberances or rings project
toward the casing of the air sac 10, displacing it inwardly, thus
providing vertical stability of the air sac 10 with respect to the
casing 13, the ribs 14, and the supports 17 and 18 and the SACH
foot 21. This is an important and advantageous feature of the
invention, since otherwise considerable vertical slippage has been
encountered, between the air sac 10 and the casing 13, in the
actual use of the device.
It is a further important feature of this invention that the
webbing or straps 16, or equivalent devices, are provided
immediately beneath the distal end of the air sac 10. This is
particularly true in the case of a preferred form of air sac, as
shown in the drawings, having an annular distal end 24, 24. The
webbing 16, in the normal use of the prosthetic device, exerts a
force upwardly against the distal end 24, 24, in the direction
indicated by the arrows f, f, providing active support for the
distal end of the air sac, which in turn reinforces the active
nature of the further forces f', f' between the distal end of the
air sac 10 and the end of the amputative stump S. This is a most
important and advantageous feature of this invention, since
otherwise there is severe danger of the so-called "mushrooming"
effect, whereby edema has been found to develop and to accumulate
in the distal end of the stump S. The webbing 16 is also a
protective device in the case of sudden deflation of air sac 10,
and prevents catastrophic damage to the stump S.
It will be appreciated that a wide variety of changes may be made
without departing from the scope of the invention by substituting
various other active shock absorbing supports in place of the webs
or straps 16, provided such supporting means exerts an active force
upwardly on the distal end of the air sac 10. For example, the
space beneath the distal end 24, 24 may be filled with straw, foam
rubber or other resilient supporting material which is capable of
exerting an active force upwardly in the manner of the forces f, f.
As another example, a spring loaded device such as a dashpot or the
like may be used, preferably having a padded surface for the
absorbtion of shock in the event that the pressure should
accidentally be lost in the air sac 10.
It will be observed that the air sac 10 has an air valve 25 through
which air can be conveniently introduced or released, in order to
fill or to empty the air sac or to adjust the air pressure to a
desirable level.
It has been discovered that the provision of an air sac 10 having
an annular, sealed distal end 24, 24 is of great advantage. It can,
of course, be applied very easily around the amputative stump. It
may, indeed, be stored in a flat, sheet-like manner when it is not
inflated, and may be wrapped gently around the amputative stump S
and then secured as by a longitudinal zipper or the like, in the
desired position. It may then be inserted into the casing 13 in the
correct position with the distal end 24, 24 wholly or partially
surrounding the end of stum S, adjacent to the straps 16 and air
introduced and brought to the desired pressure through the air
valve 25.
It has been discovered that, because of a "milking" phenomenon
attributable to the annular distal end 24, 24, post-operative edema
has been rapidly cleared up by the mechanical action of the
surrounding annular end of the air sac upon the amputated area of
the stump S, resulting in much more rapid, complete and
satisfactory recovery for the patient.
It is believed that the rapid elimination of post-operative edema
is caused by the patient's own activity in alternately driving the
stump down into the air sac and removing weight, in an alternating
style as a part of the walking operation. This mimics the
physiologic muscle contractions which are the main means of
returning fluid from the extremities to the heart. The air sac 10,
as shown in the drawings, is empty except for the presence of air
and there are no obstacles impeding the free flow of air from place
to place within the air sac 10. The milking action is greatly
enhanced by the presence of the outer casing 13, which prevents the
air sac from ballooning outwardly excessively, and which exerts
pressure uniformly on the stump. In the same manner, the supporting
means such as the straps or webs 16, for example, perform an
analgous function at the distal end of the air sac 10. Accordingly,
the following features are achieved and advantages enjoyed in the
early use of a prosthetic device according to this invention:
1. Confinement of forces in a confined space, prohibiting abnormal
distortion within the air sac.
2. The establishment of uniform vector forces directed inwardly at
essentially all portions of the stump.
3. Provision of protection for the patient, ensuring his safety and
preventing sudden deflation of the air sac 10, and even preventing
catastrophy in the event of sudden deflation.
4. The provision for uniformly distributed pressure on the stump,
even while the patient is resting. The provision of such uniform
pressure, even at the distal end of the stump, provides the patient
the benefits of a uniform pressurized environment for the stump,
all without creating any problems of skin irritation that are often
created with an elastic bandage, which is difficult to wrap with
uniform pressure and sometimes produces a "tourniquet" effect.
It will be appreciated that the casing 13 may be made of any
desired rigid material. Although fiberglass is excellent for its
strength and light weight, various metals may be substituted.
Although the casing 13 may be composed of an opaque material if
desired, it is often very helpful to provide it as a transparent
material, so that the attending physician may have an opportunity
to observe the condition of the stump and the effectiveness of the
prosthetic device visually. Other materials may also be selected,
all within the skill of the art.
It will be appreciated that similarly, the air sac may be composed
of any desired material, but plastic air sacs have been found to be
quite advantageous. The air valve 25 serves conveniently for
inflating the air sac, and a small separate air tank of appropriate
size and design may be selected for use in combination with the air
sac 10 in the actual use of the prosthetic device.
It will also be appreciated that various protuberances of different
sizes and shapes may be substituted for the rings that are shown in
FIG. 1. The important consideration is that they project inwardly
and cause a deviation of the smooth contour of the air sac 10,
providing a gripping effect between the air sac 10 and the casing
13. This provides an excellent phenomenon of vertical stabilization
which is an important and advantageous feature of the
invention.
Accordingly, it will be appreciated that this invention provides a
novel combination including an air sac which is intimately in
contact with the amputative stump, a rigid covering means which
prevents inadvertent puncturing of the air sac and adds stability
and resistance to the air sac, and a webbing or other supporting
means which extends across the space beneath the distal end of the
air sac, confining the air sac as does the casing 13, all
contributing to a synergistic effect, providing a surprising
"milking" action on the end of the stump S to reduce edema. This is
particularly important in connection with use of the device shortly
after the amputation procedure has been effected.
Although this invention has been described with reference to
certain specific forms thereof, it will be appreciated that various
changes may be made, including substitution of equivalent elements
for those shown and described, the use of certain features
independently of other features, and reversals of parts, all
without departing from the spirit and scope of the invention as
defined in the appended claims.
* * * * *