Join medical resident Siobhan Deshauer, MD, as she shadows a prosthetic resident. Learn how prosthetics are made and meet Wayne, who had a below-knee amputation following a workplace accident.
Following is a rough transcript (Note that errors are possible):
Siobhan Deshauer, MD: Hey, guys. I'm Deshauer, a 5th-year medical resident, and today I'm spending the day shadowing a prosthetist. This is a healthcare provider who specializes in making prosthetics. It's a side of medicine that most people don't get to see, so I'm really excited to bring you along with me.
Kylee: Hi, Deshauer!
Deshauer: Hey, Kylee!
Kylee: Hi, welcome. Welcome to our prosthetic and orthotic workshop.
Deshauer: This place looks amazing.
Kylee: Yeah, we have lots of cool stuff around, so I'm happy to give you a tour.
Deshauer: Yeah, let's do it.
Kylee: All right.
Deshauer: This is Kylee, a prosthetic resident in her final year of training. Today, we'll be seeing patients in clinic and you'll meet Wayne, a man who recently had a below-knee amputation after a workplace accident.
I have learned that to create a new prosthetic it takes about 1 to 2 months. Today, we'll show different parts of that process and show different prostheses at different points of production.
First, the patient is assessed by the prosthetics team, which includes a doctor, physiotherapist, and a prosthetist like Kylee. If the surgical wound is healed and the patient is strong enough, the process begins.
Kylee starts by creating a plan for each part of the prosthetic.
Kylee: The first thing we want to talk about is the socket style. For each level, there are different types of socket designs or styles that we would consider. Then we'll talk about the interface -- so what is going to be actually touching the patient's skin.
Then we need to talk about suspension, so how is this going to stay on the patient's body, and then where you would look at component traits -- things like your feet and your knees -- and also what's going to attach those things to each other so that we can make the most optimal alignment.
Then finally cosmesis, so what the device is going to look like in the end.
Deshauer: Patients can choose a realistic model made from materials like silicone or they can personalize it with their favorite colors or patterns. Once the planning stage is over, Kylee gets started with casting the patient's residual limb.
Kylee: Perfect.
Deshauer: Wow! Fantastic!
Kylee: Yeah. There we go. We'll take the Saran wrap out, and you can see how the lines have transferred through too.
Deshauer: This negative cast is then filled with plaster to create a positive cast. When the plaster is dry, the negative cast is ripped off, and now it's ready for Kylee to keep working on it. She then modifies the plaster cast to off-load areas of high pressure by shaving down some parts and building up others with extra plaster.
Kylee: I love that part and being able to really use my hands to create an end product that is going to help someone at the end.
Deshauer: Once the cast is complete, the prosthetic technicians take over to actually create the device.
First, thermoplastic is heated. Then it's molded around the plaster cast using a vacuum to create a perfect fit. Transparent plastic is used for the initial socket so that they can easily identify areas of high pressure on the patient's skin and make adjustments.
Next, the socket is attached to metal components using a strong glue that the techs calls gunk. Then the shape is completed with a lightweight foam which is made by mixing a toxic chemical called isocyanate with a special resin. When they are combined, they react and create a foam. If you look closely, you can see the extra foam pouring out as it expands.
Then the socket is laminated to make it stronger, and the techs use a vacuum to control how quickly the resin flows down the device. In this case, the patient requested the black color, which makes it really easy for us to actually see this step. Once the laminate has cooled and hardened, we finally got our finished product ready for a fitting with the patient.
Finally, patients at her institution go through the amputee rehabilitation program to ensure they can safely use their prosthetic limbs independently. They work with a psychiatrist, physical therapist, occupational therapist, social worker, recreational therapist, and dietitian before finally taking their prosthesis home with them.
[PAGER BEEPS]
Oh, my gosh. I know that sound.
Kylee: This means just that our patient is here. Our 10:30 patient is a bit early, but that's good.
Deshauer: This is Wayne. Less than a year ago, he was in a workplace accident and suffered severe injuries to his left leg. Wayne, do you want to share a bit about what brought you here? What led you to the amputation and being here today?
Wayne: I was involved in an accident in September of last year and they tried to keep my leg. They said there was an 80% chance I could keep it. I got released on October 28th with my leg and I went to physiotherapy and started that.
Then about 3 weeks later I had pain in my leg. I guess the rod they put in didn't agree with my body.
Then I see my orthopedic surgeon, and he told me what was going on and that I had two options. One was to try and keep it again or to take it off, and I chose to remove it.
Deshauer: Wow! That must have been a huge decision.
Wayne: It is. The hardest part would have been from December to March when I had no leg and I couldn't do anything. I relied on a wheelchair and just trying to cook -- anything you can't do, right? I should have been dead and I was lucky.
I lost 5 days of my life. I was in a coma. My wife had to deal with that, so that was really hard. When I woke up I didn't think anything like, "Oh, what are you worried about? I'm alive," blah, blah. But I mean it takes a toll. It's more not focusing on the people that are in because there is nothing you can do about it. It's the people that need the help outside that won't ask.
That's the thing, but it's how everybody came together. All my friends, the nursing staff, and the prosthetist -- I mean they truly put their heart and soul into it.
But the thing that bothered me the most is my grandson is 6 and he just started hockey 2 years ago, and so with COVID he didn't get to play last year. But he loved hockey. I want to be able to go and skate with him. I play on this Sunday. It will be my first game to try and go back to it.
Deshauer: Wow!
Wayne: ... but at least I'll know if I can skate. If I can't play hockey, I'm fine with that. But to actually just skate with my grandson, that was the one thing that if I didn't get to do that, I think that would crush my spirit a bit.
Deshauer: Now, on to Wayne's actual reason for being here, his appointment with Kylee.
Wayne: See? So right there.
Kylee: Yeah.
Wayne: This is where the redness is. This is not so much. That's the top anyway.
Kylee: This is the new one line.
Wayne: Yeah, and that's the new line. It is a lot better today as far as pain. I think it was still sore because of yesterday.
Kylee: I think we have decided that the pressure is right here?
Wayne: Yes.
Kylee: Okay. I'll mark that with lipstick, and then I'm just going to mark where the end of your bone is too so I can see that. Feel free to move around. You can take a few steps.
We just used lipstick in order to transfer where that pressure is in the socket, and now I know that that's the area that's causing too much pressure and I can either grind in or heat it and push it out a little bit.
All right -- so we are going to make some adjustments to Wayne's prosthetic.
Deshauer: Yeah. That's so much smoother.
Kylee: Yeah.
Deshauer: Nice! I love that you can make changes right there on the spot. It's so convenient for patients. How often do they actually come back for follow-ups?
Kylee: At the beginning, they typically have follow-ups every 2 weeks. But anytime there is a change or the patient notices that things are different or if they have any concerns, they can call to book in.
Deshauer: It's really like this lifelong relationship with someone?
Kylee: Yeah. It is lifelong, although the 2-week follow-ups aren't something that happens all the time. It's just really when we're fine-tuning things.
Deshauer: Between making the modification to the actual prosthetic plus adding the socket, hopefully he won't have that pain then.
Kylee: Yes, that is the goal.
Deshauer: Excellent. Okay. Let's see.
Kylee: Alrighty.
Wayne: Yeah.
Kylee: Let's try this.
Wayne: My [...] was sitting on a chair.
Kylee: Yes. How does it feel at first just putting it on?
Wayne: Good.
Deshauer: Kylee is watching Wayne's gait closely, assessing the alignment of his prosthesis and how he is walking, to see if any other adjustments are needed.
Wayne: Yeah. It feels better.
Kylee: Alright. Let's try that, I think.
Wayne: I think so too.
Kylee: Yeah.
Wayne: Try that and then awesome. Thank you so much.
Kylee: You are so welcome. Looking good.
Deshauer: Wow! I feel so inspired after talking to Wayne. I mean, what an incredible man. You talk about resilience and being able to pick yourself back up, feel gratitude, positivity, goals for the future, and all of this in like 9 months since a horrific accident. I feel overwhelmed, speechless and inspired by him. I am just hoping for the very best and that the skating goes well and so he meets that goal he set for himself. Be sure to watch to the end of the video so you can see how he does skating.
So far we have mainly been seeing below-knee amputations, but I know you guys do so much more than that. Is it possible to see some other prostheses?
Kylee: Yeah. Absolutely. I have two examples here. I have a silicone prosthetic device for a partial hand amputee and over here I have an above-knee prosthesis for a transfemoral amputee. We also do all kinds of functional devices, especially for kids who are looking to do all kinds of wild activities.
Alrighty. We can start with our conventional hand that opens and closes. We also have options like a scoop to help play in the sand perhaps or catch a ball, two-hand activities. Then speaking of catching a ball, we have all kinds of sports options, so something like a lacrosse terminal device.
Deshauer: That is so cool.
Kylee: It is. Or a swim device to help in the summer months when you're swimming in the pool or on the beach.
Deshauer: Amazing.
Kylee: And even something to help play on the jungle gym while you're kind of out at recess or playing with your friends. The way this can work is we can unscrew the terminal device, which is functioning as the hand from the end, or what we would refer to as the wrist, and then swap out different terminal devices so that the patient is able to use one socket with multiple different terminal devices.
Deshauer: Aw! But I love this diversity. This is so exciting for kids. Oh, that makes me really happy.
Kylee: Absolutely. Yeah. The problem solving is like one of the most fun parts of everyone has a different goal and a different task that they would like to complete and so how can we help you do that and accomplish that goal.
Deshauer: What a day! This has been incredible. I have learned so much. I feel so excited about this field and I really want to give a huge thank you to Wayne for sharing his story and, of course, for Kylee for allowing me to shadow her for the day, and the entire prosthetics team for opening up their workshop and showing us what they do. I have just seen so much creativity, skill, and this collaboration within a team it's so inspiring.
There he is. Wayne didn't just skate, he managed to play hockey the first time he was back on the rink. What an incredible accomplishment!
In my next video, I'll be showing you myoelectric devices. There is just too much in the world of prosthetics to fit into just one video, so be sure to subscribe so you don't miss it. I'll see you in the next video. Bye for now.
Siobhan Deshauer, MD, is an internal medicine resident in Toronto. Before medicine, she was a violinist, which is why is called Violin MD.