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Post-operative oedema reductionEnhancing patient recovery after elective foot and ankle surgery

Managing post-operative oedema following foot and ankle surgery

Post-operative swelling following elective foot and ankle (F&A) surgery can significantly impact the activities of daily living, in general, and recovery can last up to three months or longer1.

F&A swelling may result from the post-operative rehabilitation protocol which the patient has to adhere to post discharge, for example, partial weight bearing with a heel wedge shoe and elbow crutches. Such guidelines negate the activation of the veno-muscular pump in the lower limb which prevents the foot and ankle muscle pumps from working as normal. The effect of this process can lead to swelling and associated complications. Impaired wound healing may occur in 2-4% of patients as a result of post-operative swelling2.

Interventions that prevent and reduce the duration of post-operative swelling will serve positively to patients and can provide significant benefits to patients and healthcare providers3.

Current guidelines for post-operative care include:

• • Cryotherapy

• • Compressive dressings

• • Elevation

• • Partial or non-weight bearing in specialist footwear and elbow crutches

• • Physiotherapy

• • Intermittent Pneumatic Compression (if deemed necessary)

A new approach

Providing lower limb muscle contraction for the prevention and treatment of oedema

Easy-to-use, the geko™ is a battery powered, disposable neuromuscular electrostimulation device designed to increase blood flow in the deep veins of the leg4.

The geko™ device gently stimulates the common peroneal nerve contracting the calf and foot muscle pumps to prevent and treat oedema.

The increase in blood flow is equal to 60%5 of walking without a patient having to move.

60%

Weighs just 10g. Quick and easy to fit.

10g

No wires or leads. Small, light and comfortable to wear. Silent in operation.

Zero

The gekoTM device is clinically proven to prevent the build-up of post-operative oedema6

A recent study by Mahmood et al7 illustrates the effectiveness of the geko™ device in the management of pre-operative oedema in ankle trauma patients. This study suggests that it is effective in reducing ankle oedema and accelerates patients’ readiness for theatre compared to standard measures, on average two pre-operative bed days were saved7.

The same mode of action can be applied for the management of post-operative oedema in elective foot and ankle surgery and has been clinically proven in other lower limb applications6.

Case study: 40-year-old female right scarf lateral release akin osteotomy8

Patient diagnosed with hallux valgus and required surgery due to severe pain, reduced flexion and extension in the first metatarsal. The geko™ device was introduced into the treatment protocol to accelerate the reduction of oedema and to increase blood flow.

The geko™ device was applied immediately post-surgery on day 2 for 22 hours, on day 3 for 24 hours and days 4-10 for 4 hours.

The geko™ device was well tolerated by the patient and at day 4 the patient was judged as progressing “extremely well”. Swelling had reduced significantly since the operation, and there was reduction in pain Visual Analogue Score (VAS) from 8/10 to 1/10 in the four-day period after the operation.

The wound was healing well with a lower level of bruising than expected. At 4 days post-operatively there was an increased range of motion (ROM) and assistive range of motion (AROM) of the 1st metatarsal.

Day 1 Post-operative (1 hour after surgery).

Day 4 The patient was partial weight bearing with a heel wedge shoe and walked with elbow crutches.

Providing effective oedema management following F&A surgery

• • The safety and effectiveness of the geko™ device in ankle fracture management had been established7.

• • Significant reduction in pre and post-operative oedema7,8.

• • Results show an improvement in the time to be “ready for theatre” because of oedema resolution7.

• • Patient compliance with the geko™ device is reported as well tolerated7.

• • The geko™ device can deliver significant clinical and economic benefits to the patient and their health care team respectively7.

Firstkind Ltd,Hawk House, Peregrine Business Park High Wycombe, Buckinghamshire HP13 7DLUnited Kingdom

T. +44(0)1494 572040 W.www.gekodevices.com

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References

1. https://www.bofas.org.uk/

2. Rippstein P, Tiziano Z. The ‘Scarf’ osteotomy for the correction of hallux valgus. Orthopaedics and Traumatology. 2001;9(2):101-12.

3. Keehan R, Guo S, Ahmad R, Bould M. Impact of intermittent pneumatic foot pumps on delay to surgery following ankle fracture. Foot Ankle Surg 2013 Sep;19(3):173-176.

4. Nicolaides A & Griffin M. Measurement of blood flow in the deep veins of the lower limb using the geko™ Neuromuscular Electro-stimulation device. International Angiology 2016 August;35(4):406-10.

5. Tucker A et el. Augmentation of Venous, Arterial and Microvascular Blood Supply in the Leg by Isometric Neuromuscular Stimulation via the Peroneal Nerve. Int J Angiol. 2010 Spring; 19(1): e31-e37.

6. Wainwright TW et al. A Feasibility Randomised Controlled Trial to Evaluate the Effectiveness of a Novel Neuromuscular Electro-stimulation Device in Preventing the Formation of Oedema Following Total Hip Replacement Surgery. Heliyon 18 Jul 2018- Volume 4, Issue 7.

7. Mahmood et al, Neuromuscular Electrostimulation Device Reduces Preoperative Edema and Accelerates Readiness for Theater in Patients Requiring Open Reduction Internal Fixation for Acute Ankle Fracture the foot and ankle journal, published online, March 2020.

8. Pillai, Case study: Using the geko™ device to prevent oedema and promote functional activity following foot surgery, case study 1, data on file, published online, 2019.