JOBSKIN速 PREMIUM MTM Pressure Garment
Measuring and Fitting Manual
Jobskin Ltd Unit 13a Harrington Mill Leopold Street Long Eaton Nottingham NG10 4QG
www.jobskin.co.uk
Leading the way in rehabilitation therapy
Content
Design Choices
Modifications
Measuring Guide
Contents Page
The Jobskin Service.................................................... 3 How to use the Measuring and Fitting Guide ...... 5 Foreward ........................................................................... 5 Order Information .......................................................... 6
Head and Neck section ............................................. 9 Garment Styles ............................................................... Design Choices............................................................... Modifications ................................................................... Measuring Guide............................................................
11
Torso section .................................................................. Garment Styles ............................................................... Design Choices............................................................... Modifications ................................................................... Measuring Guide............................................................
17
Arm section ..................................................................... Garment Styles ............................................................... Design Choices............................................................... Modifications ................................................................... Measuring Guide............................................................
27
13 13 14
19 21 22 23
29 32 32 33
Hand section ................................................................... 35 Garment Styles ............................................................... 37 Design Choices............................................................... 40 Modifications ................................................................... 41 Measuring Guide............................................................ 41 Lower Extremity section ............................................ 45 Garment Styles ............................................................... Design Choices............................................................... Modifications ................................................................... Measuring Guide............................................................
47 52 52 54
Contact Details ............................................................... 59
Jobskin
The Jobskin Service How to use the Measuring and Fitting Guide Foreward Order
Content
How to use
Modifications
Measuring Guide
How to use the Measuring and Fitting Guide The body has been divided into 5 areas each of which forms sections numbered as follows: 1 Head and Neck 2 Torso 3 Arm 4 Hand 5 Lower Extremity
Head and Neck
Arm Torso
All the information relating to the particular area of the body i.e. 1 Head and Neck can be found in that section under the following headings:
Hand
Garment Styles: The range of garment styles available
Lower Extremity
Design choices: The different choices of design that can be incorporated into the garments Modifications: Modifications that can be made to the garments in addition to the design choice in order to customise the garment according to your patient needs. Measuring Guide: A step-by-step guide to measuring for the garment
Content
How to
Foreward
Measuring Guide
The Pressure Garment Manual The Jobskin Premium Pressure Garment Measuring and Fitting manual has been designed to assist you by giving detailed information on measuring, fitting and applications of Jobskin Premium garments. We hope that you will find this manual an essential and useful guide to Jobskin Premium Pressure Garments as part of the service offered by Jobskin Ltd. 5
Content
How to
Foreward
Order Form
Before sending your paperwork, ensure it has been completed in full PLEASE USE CAPITALS 1. Patient Order Form - New patient or new information: • The Order Form is the most important form, please carefully complete all fields. Please ensure you have entered a diagnosis in order that we can design the garment with the appropriate pressure range for the condition being treated. • The Order Form is designed to be used by a wide variety of customers, please provide us with all the details necessary in order that we can make garments promptly and efficiently and according to your requirements. • You must state a hospital order number where applicable, and a date of birth for every order. If shipping direct to the patient please ensure you provide a post code where required. 2. Garment Re-Orders: When ordering a repeat order an Order/Re-Order Form must be completed in full. If a repeat order has any changes or new measurements the appropriate Jobskin data form must also be completed. 3. Garment alterations and returns: When it is necessary to alter or replace a garment, a Jobskin returns form should be completed in full and returned with the garment. • We must have clear instructions for the required alteration so we are able to ensure that the replacement is correct for your patient. • For returns we need to know why the replacement is being requested.
Please Note: For health and safety reasons all garments must be laundered before they are returned. Customer returns What to do if the garment does not fit? • New measurements must be recorded on the approprate forms 1 Head and Neck: Jobskin Data Form - 502 2 Torso: Jobskin Data Form - 503 3 Arm: Jobskin Data Form - 504 4 Hand: Jobskin Data Form - 505 5 Lower Extremity: Jobskin Data Form - 506 and 508 • Complete a customer return form • The more measurements and information you supply will help us to identify and rectify the problem 6
Content
How to
Foreward
Order Form
After Care Jobskin Garments Jobskin Wear: • Jobskin pressure garments should be worn continuously for 23 hours in order to achieve the best possible outcome. They should only be removed for bathing, creaming and massaging or as advised by the prescribing therapist. • Two sets of garments should be ordered so that one can be washed whilst the other is being worn. • The average period of wearing a jobskin pressure garment is 12 - 18 months or until the scarring has matured. • If a garment becomes slack or damaged, it should be replaced as soon as possible. • Garments should be protected during manual work to prolong the life of the garment. Gloves and masks may be removed for eating. • Apply and remove your garment as instructed by your Therapist. Care should be taken with zippers and seams, never pull a garment by the seams or the elasticated band as this will cause detioration and loss of elasticity. Never turn down or cuff a garment. • A garment should feel snug but not too tight that it feels uncomfortable. It has to be quite a snug fit to be effective and it may take a little time for your patient to get used to it. • The suns UVA ray's can penetrate through the lycra material therefore it is essential to protect the skin and always use a recommended sun protection cream. A total sun block can be used under a garment or a cotton garment can be worn over the top of the pressure garment. Jobskin Venous Pressure Gradient Garments: • Should be put on first thing in the morning and removed last thing at night. • The length of time for wearing the Jobskin Venous Pressure Garments must be determined by the doctor and depends on the severity of the patients condition. Some patients need to wear them for only a few months, others will have to wear them for the rest of their lives. Jobskin Care: • The following points should be noted as they may damage the fabric, reduce the elasticity and the effectiveness of Jobskin Garments. • Avoid using creams containing wax, paraffin, or petroleum. We recommend water based or silicone based moisturiser or cream. • No residue cream should be left on the skin after creaming and massaging as this will deteriorate the fabric and decrease the life of the garment. • If a garment is worn whilst swimming, it must be rinsed out immediately to remove any chlorine or sea salt. • Exercise and normal activities should be continued whilst wearing garments. • Garments should not be worn in the bath or shower. • If gardening, housework or manual work is undertaken, protective gloves i.e cotton or rubber should be worn over the top to protect the garment. 7
Content
How to
Foreward
Order Form
Jobskin Washing Instructions: Garments should be washed daily to remove acids and salts absorbed from the body. This will prevent infection and help your garment to last longer as washing rejuvenates the fabric. 40 30
Machine wash at 40oC
Do not bleach
Do not iron
Do not dry clean
Do not tumble dry
Dry flat
Drip dry
Please Note: Fabric conditioner should not be used.
Jobskin Warranty All Jobskin Pressure garments are guaranteed for workmanship for 30 days. Notification of garments which do not fit should be made within 7 days from date of fitting. Alterations or re-manufacture is then undertaken free of charge. Jobskin is not responsible for incorrect fitting due to: • A reduction or increase in body weight. • Any changes following surgery. • Incorrect form filling such as incorrect style options or recording of measurements. • Any garment which does not fit due to a delay on the part of the Hospital or patient attending for fitting. Please Note: Jobskin will not accept any liability for garments which have had alterations or modifications, other than those carried out by Jobskin Ltd. 8
Head and Neck
Head and Neck section Garment Styles Design Choices Modifications Measuring Guide Jobskin Data Form - 502
Garment Styles
Design Choices
Modifications
Measuring Guide
Introduction When considering a mask style, the location of the scar, the underlying skeletal structure and the soft tissue areas of the face will affect the style selection. When pressure garments are used to manage facial scarring, it is recommended that an orthodontic review is undertaken.
Full Face Mask
0540
For scarring to: • Nose • Forehead • Around ears • Chin • Mandible • Neck • Around eyes Closes at back with Velcro. Due to facial contours, pads or conformers may need to be used in conjunction with mask as a full face mask may not provide adequate pressure alone.
1158
Open Face Mask For scarring to: • Above and below ears • Chin • Mandible • Neck • Forehead
Open Face Mask with Lip Strap For scarring to: • Above and below ears • Chin • Mandible • Neck • Mouth • Forehead This mask is constructed with a lip strap which forms a separate opening for the mouth. 11
1158
Garment Styles
Design Choices
Modifications
Measuring Guide
0550
Regular Chin Strap For scarring to: • Chin • Middle portion of mandible not extending above, below or in front of the ear Can be used in conjunction with a soft foam collar achieving an unbroken line of pressure the full length of the scar. Open at back of head and fastened with a Velcro closure.
0549
Modified Chin Strap For scarring to: • Chin • Mandible • Above, below and in front of ear • Anterior neck Can be used in conjunction with a soft foam collar achieving an unbroken line of pressure the full length of the scar. Opens at back of head and fastened with a Velcro closure.
0545
Chin Extension Collar A soft foam collar covered with fabric to: • Keep neck in extension • Reduce possible contractures • Pressure is not provided Note: Please give height of collar required. Maximum thickness of foam, 5cm (2”).
12
Garment Styles
Design Choices
Modifications
Nose Covering
- Provides pressure to bridge and tip of nose. - A contour splint is recommended under full face mask possibly with padding. - Give measurements A and B on the Jobskin Order Form 502.
Open Head Mask
- This style is open from the eyebrows to the same distance at the back of the head. - There is a strap from centre back to centre back.
Garment Styles
Design Choices
Modifications
Measuring Guide
Measuring Guide
Head Band
Closed Ear Flap Lip Covering
Detachable Turtle Neck
0014 Closed Ear Flap
- Can be incorporated into face mask or modified chin strap.
0017 Head Band
- Separate head band. - Measurement number 2 and width required.
1166 Lip Covering
- A detachable lip covering to provide pressure to the lips. - Can be removed for eating. - Can be included on both face mask and chin strap.
0034 Detachable Turtle Neck
- Made from elastic, 2.5cm (1�), 5cm (2�) or 7.62cm (3�) wide. - Used to provide pressure.
0027 Pockets
- This modification allows for the insertion of padding in areas where pressure is difficult to achieve. - The position and size must be indicated on face drawing form 502 or on a piece of paper 13
Garment Styles
Design Choices
Modifications
Measuring Guide
Tools required • • • •
Jobskin Data Form - 502 Regular measuring tape Ruler Flat object of stability or another straight ruler
Procedure All numbers correspond to the numbers on the Jobskin Data Form - 502
2
3
1 4
Key: • Orange = Linear measurement
5
• Black = Circumference measurement Number
Required Measurements
Method
1
Centre corner of mouth to base of chin
Linear - Use a book or ruler held under chin to mark level
2
Around head above eyebrow level
Check hair thickness
3
Around head at chin angel
Place tape beneath the chin at throat level, extend in front of ears straight up to top of head on both sides as shown on diagram
4
Neck
Around neck at 'adams apple' level
5
Throat to sternal notch
Linear- Length from base of chin at angle of neck to sternum 14
Garment Styles
Design Choices
Modifications
Measuring Guide
Key: • Orange = Linear measurement • Black = Circumference measurement
Number
Required Measurements
Method
6
Width of eyes from outer corner of left eye to outer corner of right eye
Linear - Take measure over the eye brows
7
Top of ear to base of ear
Linear - If any portion of ear missing please state on data form
8
Corner mouth to corner of mouth
Linear- Measure in relaxed state
6
7
8
Letter
Required Measurements
Method
Broadest part of nose
Contour Only take for nose covering
1
B A
B
Length of nose
Linear Only take for nose covering 15
A
Torso
Torso section Garment Styles Design Choices Modifications Measuring Guide Jobskin Data Form - 503
Garment Styles
Design Choices
Modifications
Measuring Guide
0525
Sleeveless Vest For scarring to: • The abdomen and lower back only • With open armholes pressure is lessened • Never use in conjunction with separate sleeves
0527 0528
Vest with Long Sleeves Vest with Short Sleeves For scarring to: • The trunk • Arms distal to the elbow area • If scarring extends to wrist - consider detachable gauntlet in addition to vest • Gauntlet attached to sleeves is not a recommended style • If any dependent oedema issues are present in the hand, add a detachable gauntlet • A combination of short and long sleeve may be selected if desired
19
Garment Styles
Design Choices
Modifications
Sleeveless Body Brief Body Brief with Long Sleeves Body Brief with Short Sleeves
Measuring Guide
0530 0532 0531
For scarring to: • The back, above the breast area, shoulders and the arms • Select short sleeve design following guidelines as instructions for vest with short sleeve • Select long sleeve design following guidelines as instructions for vest with long sleeve • If desired you may select different sleeve lengths according to scar location Note: All body briefs are constructed with a front or back zipper closure. The standard pubis finish is closed with Velcro.
Sleeveless Bodysuit Body Suit with Long Sleeves Bodysuit with Short Sleeves
0558 0560 0561
For scarring to: • Trunk, abdomen and thighs • • •
Follow guidelines as per body brief Select sleeve length as for vest guidelines If desired you may select different sleeve lengths according to the scar location
Note: A body suit can be constructed with the legs to the knees or to the ankles. All body suits are constructed with a front or back zipper closure. The standard pubis is open but can be ordered closed if desired.
All Vests and Body Suits All female vests with bra cup size AA and above must have bra cups in vests, body briefs and bodysuits. 20
Garment Styles
Design Choices
Modifications
Measuring Guide
Turtle neck Mesh axilla
Open axilla
Zippers front or back
-
Avoid placing zippers over scar area Use zippers carefully as a certain degree of pressure may be lost Back zipper recommended for children. Consider front zipper for patients with restricted mobility or for independence. Zips may be incorporated into arms for specific cases
Velcro Closure front or back
- Useful for children to allow growth expansion. - Please Note closure may be more difficult and if not closed fully a certain degree of pressure may be lost. - For reduced mobility select front Velcro closure. - Garments for ladies with bra cups cannot have front Velcro closures.
Scoop Neck
- Select for scarring which does not extend to chest area. A scoop at the front only is recommended, please write on form in comments box. Options on the Jobskin Data Form - 503.
Turtle Neck
- Select if burn extends to anterior neck surface. Recommended for scarring above chest level.
Raglan Sleeve
- Standard on all vests.
Lining to Axilla
- To protect fragile skin, may give extra pressure.
Open Axilla
- For use with open or fragile skin. - Not a recommended option.
Mesh Axilla
- For increased ventilation where no scarring is present and no pressure is required.
Insert to Axilla
- Standard insert for vests, this design has a centre seam.
Gusset to Axilla
- Consider this choice for axilla scarring as it contours anatomically. This design does not have a centre seam.
Elastic finish - Short sleeve vests are finished with elastic cuff as standard. distal end sleeves - Long sleeve vests are finished with an overlock edge as standard. Cropped Vest
- Consider scar area carefully when selecting this design as it provides minimal cover and pressure to the trunk is lost. 21
Garment Styles
Design Choices
Modifications
Measuring Guide
Pocket Lining inside elbow Nappy strap
0001: Nappy strap
- Standard length, available on vests only.
0018: Torso Band
- Fitting around torso from buttocks to chest. The measurements required are the circumference around the chest, waist and at the end of the garment. Give the length between the top and bottom of the garment, and between the top and waist.
0034: Detachable Turtle Neck
- 2.5cm (1’’), 5cm (2’’), or 7.6cm (3’’). Can be worn with face mask for complete coverage.
0027: Pockets
- Opening to facilitate the placing of padding. Position and measurements must be given.
1163: Velcro Tabs
- To attach to waist heights.
1167: Lining - To protect fragile skin and to provide comfort if required. inside elbow 1168: Lining full elbow
- To protect fragile skin.
1164: - Arm zippers normally extend from the end of the garment to the axilla on Zipper under 20cm the lateral side. Specify the length and position you require. Available on 1165: medial or lateral aspect. Zipper over 20cm 1170: Gauntlets
- Gauntlets attached to a sleeve vest are not recommended. A gauntlet must be used if the scar extends over the wrist and must be considered whenever oedema of the hand is present or likely to occur.
1175: Double abdominal panel
- Used to give support to a pendulous abdomen or collapsed stomach muscles, usually used in conjunction with an uplift panel.
1176: Uplift panel
- Extra pressure panel over abdomen to help hold up collapsed muscles in the stomach.
1161: - Reduced pressure over the abdomen area, made out of soft material. Reduced pressure Recommended for patients who cannot tolerate abdominal pressure. abdominal panel Bras:
- For insertion to bra vest. Sports type bra preferred. Can be supplied or purchased by patient. 22
Garment Styles
Design Choices
Modifications
Measuring Guide
Tools required • • • • • •
Jobskin Data Form - 503 Regular measuring tape Jobskin measuring tape - coloured blue if arms are required in garment Jobskin measuring tape for legs - coloured red, if legs are required in garment Adhesive tape Measuring stand
Procedure The patient should be standing and measurements taken with a regular measuring tape. Surface circumferences and linear measurements to be taken from the back. If the patient cannot stand upright the measurements should be taken with the patient lying on their side. All these numbers correspond to the numbers on the Jobskin Data Form - 503. Key: • Orange = Linear measurement • Black = Circumference measurement Measurements required for all styles of torso garments
4 3 1
2
Number Required Measurements
Method
1
Shoulder circumference - left
Ask the patient to place their hands on their waist and take the measurements with the arm at this angle. Bring the tape under the axilla, curve it around, finishing on the acromian process
2
Shoulder circumference - right
As for Number 1
3
Neck circumference
Around the neck at adams apple level
4
Shoulder width - only required for sleeveless vests
Measure from the actual point on the shoulder to the base of the neck 23
Garment Styles
Design Choices
Modifications
Measuring Guide
Key: • Orange = Linear measurement • Black = Circumference measurement
6
7
10
12 Number Required Measurements
11 Method
6
Chest circumference
Chest at level of axilla. The same measurement is taken for male and female (This is not a bust circumference)
7
Waist circumference
Place hands on hips and take measurement. Tip: Mark level on waist or leave a tape measure in place
10
Circumference at largest part of buttocks
If necessary stand the patient against a wall. The first part of the buttock to touch the wall is the largest protrusion. Note: Take the circumference No. 10 and the height No. 9 measurements together.
11
Proximal thigh circumference - left Body brief and body suit only
Do not allow the tape to slant
12
Proximal thigh circumference - right Body brief and body suit only
Do not allow the tape to slant
24
Garment Styles
Design Choices
Modifications
Measuring Guide
Additional measurements for body briefs and body suits Note: - If a body suit is required, measure the legs from the groin according to the instructions for lower extremities - lower legs. - Use full length tape - red. - Take the lengths from the back of the patient.
5 9 8
Number Required Measurements
Method
5
Shoulder to waist
Place the tape at the top of the shoulder and measure the length to the waist. Take the lengths from the back of the patient. Tip: Mark the waist and take the tape straight round and measure the waist circumference. This is important as this length must be to where the waist measure is taken.
8
Shoulder to fold of buttocks contour measurement
Measure from the centre of the tip of the shoulder to the gleuteal fold of the buttocks (take high into fold). Lift the buttocks if necessary and tuck the tape into the fold. The tape must follow the contour of the buttock. Note: This is the only measurement that follows the contours of the body closely when taking linear lengths.
9
Shoulder to largest part of buttocks
Measure to the largest protrusion of the buttocks 25
Garment Styles
Design Choices
Modifications
Measuring Guide
Additional measurements for a bra vest
C
A B
Letter
Required Measurements
Method
A
Shoulder to just under breasts
Length from shoulder to just under the breast using a tape left in place as a reference, at the back of the patient.
B
Circumference just under breasts
Measure directly under the breasts.
C
Bra size circumference over nipple
Directly over the nipples. Give the patients bra size if known. Tip: leave the tape in position, then take the A measurement for accuracy.
Additional measurements for a longer vest Note: Not required for body suit or body brief Letter
Required Measurements
Method
D
Shoulder to end of garment
- Take if vest is required below the waist. - Measure from the top of the middle of the shoulder to the required length of the vest. - We recommend that the length should be taken just over the iliac crest.
E
Circumference at end of Garment
Take at required end of garment. Note: If sleeves are required, measure the arms according to the instructions for measuring arms. Using the blue tape for arms. See arm section.
26
Arm
Arm section Garment Styles Design Choices Modifications Measuring Guide Jobskin Data Form - 504
Garment Styles
Design Choices
Modifications
Measuring Guide
Introduction When the scar is confined to the arms without involving the trunk, separate sleeves can be used. They should never be used in conjunction with a sleeveless vest as this would cause bulging of the skin between the gaps in the garments and would not provide uniform pressure. Detachable gauntlets can be used in conjunction with a sleeve if required.
Detachable Gauntlet
0505
For scarring to: • Small scar areas centre hand, not extending to the MCP joints • Common option to combine with arm sleeves for scarring to lower forearm/wrist areas • Gauntlet may extend 8.8cm (31/2”) beyond the wrist A detachable gauntlet can be incorporated with any of the following styles; this can be useful if the patient is employed in a job where the gauntlet will wear out quicker than the sleeve.
Forearm Sleeve
0515
For scarring to: • Lower forearm, not including elbow or area just distal to the elbow • Make sure sleeve is long enough to address scarring • Consider adding a gel band proximal end of sleeve to prevent slipping • Advisable not to finish sleeves mid forearm for comfort and to prevent rolling up which may cause a tourniquet affect
Forearm Sleeve and Gauntlet For scarring to: • Distal 1/3 of forearm only • Will ensure adequate pressure to the wrist • A short zipper can be incorporated if required 29
0516
Garment Styles
Design Choices
Modifications
Measuring Guide
0501
Full Arm Sleeve For scarring to: • Arm without extending beyond the upper 1/3 of the biceps. • When scar extends beyond distal 1/3 of forearm add a gauntlet as sleeve alone will not provide optimum results • If there are oedema issues in the hand, consider adding a detachable gauntlet
0502
Arm Sleeve and Gauntlet For scarring to: • Arm and wrist area • Must be used if scar extends over the wrist area • Gauntlet may be detachable - Order 0501 and 0505 Note: The addition of a detachable gauntlet must be considered whenever oedema of the hand is present or likely to occur.
Arm Sleeve and Shoulder Flap For scarring to: • Arm extending to biceps region • Helps to prevent sleeve slipping down • Standard or adjustable body straps can be incorporated with design • Not recommended for scarring extending to the shoulder/acromian process
30
0503
Garment Styles
Design Choices
Modifications
Arm Sleeve, Gauntlet and Shoulder Flap
Measuring Guide
0504
• A complete length arm sleeve incorporating an attached gauntlet with adjustable or non adjustable shoulder flap. Please specify requirements.
Stump Sleeve
1140
• Provides full pressure to scarring on the stump end and upper arms.
Stump Sleeve and Shoulder Flap • As above but incorporates an adjustable/nonadjustable shoulder flap.
31
1141
Garment Styles
Design Choices
Modifications
Measuring Guide
Round shoulder flap/bra loop flap Other design choices available: • Arm/flap - standard • Arm/flap - closed with Velcro • Arm/flap - adjustable For measurements required see Jobskin Data Form 504 0013: Half arm with flap
- Small scar areas centre of upper arm
0016: Arm band
- Small scar around elbow must extend at least 2 arm tapes above and below scar elbow. We do not recommend this style of garment
Garment Styles
Design Choices
Modifications
Measuring Guide
0027: Pockets
- Added to facilitate padding to give greater pressure to difficult areas
1164: Zipper under 20cm 1165: Zipper over 20cm
- Positioned on the lateral side, if required elsewhere please specify
Sleeves: Short Long
- Edged with 2.5cm (1”) elastic, if 1.5cm (1/2”) required - please request - Standard is overlock, if elastic required please request
1167: Lining inside elbow
- For protection or comfort - Not recommended where there are contractures present
1168: Lining full elbow
- As above
1172: Adjustable shoulder flap
- Suitable for adults only
32
Garment Styles
Design Choices
Modifications
Measuring Guide
Tools required • • • •
Jobskin Data Form - 504 Jobskin measuring tape for arm coloured blue Jobskin measuring stand Adhesive tape
Procedure Take measurements with the patient seated, arm relaxed and extended in a horizontal position, with the elbow very slightly flexed. Hand should be resting on a Jobskin measuring stand for stability. 1. Label the tape with patients name and indicate right or left. 2. • • • • •
Fasten the tape in position at elbow (using elbow tape Number 9) with distal end towards the wrist. Secure with adhesive tape as red tabs are temporary fastenings. For a large extremity use extension tapes or add another strap to lengthen. Add and secure so that the numbering sequence is unbroken. If another 'strap' is added, secure to the attached strap with the plain (unnumbered) side facing up. Do not cut the extended straps short. • Leave the extended straps intact, so the exact length can be determined. • If you are transferring the measurements to the Order Form, then use a regular measuring tape (and measure from one end to the other). Note: if a gauntlet is not required and you require a shoulder flap go to no 6.
3. • Proceed from the elbow towards the wrist. • Wrap circumferential straps around the arm firmly, do not allow the skin to bulge between the straps by pulling too tightly. Secure straps with adhesive tape. • The correct pressure will be built into the garment. Usually the '0' strap will fall just below the wrist bone. Occasionally the '0' strap will fall short, if so pleat the next strap (see pleating on page 34). • Cut the tape along the scalloped side and transfer the measurements onto the Jobskin Data Form - 504 reading along the straight edge. 4. (With gauntlet) Use the tapes as shown. 5. Measure from the IP joint of the thumb with the Jobskin finger tape (see hand section). Give the length of the thumb and an outline drawing of the hand. 33
Garment Styles
Design Choices
Modifications
Measuring Guide
Measuring a Stump • Measure the arm with the blue arm tape at the distal end. • Measuring as far as the stump will allow, no need to measure over stump end. Note: If there are contractures present it is helpful to note the degree and placement. It may be advisable to request a contracture seam in the garment. Secure the arm tape with adhesive tape after removal keeping in a straight line.
Adjustable Shoulder Flap 6. If you require a shoulder flap, using a regular tape measure, measure the length diagonally from the shoulder to waist. The waist circumference is also required.
Pleating - The tape may be pleated only at the top (axilla) or bottom (wrist or Metacarpals). - If a strap does not fall exactly at the wrist or the axilla, then fold back the next strap until it is in position to wrap around the arm. - Secure these two straps along the blue spine with adhesive tape. - Read the measurements where the strap intersects the blue spine along the straight edge. - Transfer these onto the data form. - Remember to measure the distance between the centre lines of the pleated straps and fill in the appropriate box on the form. 34
Garment Styles Design Choices Modifications Measuring Guide Jobskin Data Form - 505
Hand
Hand section
Garment Styles
Design Choices
Modifications
Measuring Guide
Introduction When measuring the hand for a Jobskin glove, the timing of application is the most important factor. If the dorsal surface of the hand has been scarred, the resulting epidermis will be fragile and easily damaged by the friction caused by donning a glove. For this reason, the dorsal surface should be well healed and stable. If the pressure glove is applied too early to the hand the skin surface will often break down, requiring additional healing time before the glove is re-applied. Generally, the palmar surface will not be as vulnerable to the shearing forces created by the pulling on and off of the glove due to the elastic fabric of the glove spanning the concave surface of the palm. As it is difficult to obtain correct pressure in the palmar area, the use of splints, conformers and elastomers should be considered in the palm. Hands that have undergone primary tangential excision and grafting will be ready for fitting of pressure gloves much sooner than those that have healed primarily. This is due to the more stable epidermis of the graft rather than the scar epidermis of the re-epithelized hand.
Glove to Wrist: open or closed tips For scarring to: • Hand and digits • Digits can be constructed with a mixture of short and long lengths and open or closed tips, please see design options on page 39. Note: if you require the wrist length to be longer, then you must take the circumferential measurement at the end of the support. There is provision on the prescription Order Form to go to 3.8cm (11/2”) or 7.6cm (3”) beyond the normal wrist measurement. If you go beyond 9cm (31/2”) for adults or 5cm (2”) for children, then the support is no longer classed as a glove to wrist, but as a glove to elbow and it is recommended to extend to the bend of the elbow. 37
0535
Garment Styles
Design Choices
Modifications
Measuring Guide
0533
Glove to Axilla For scarring to: • Hand and arm • Gives good constant pressure along length of arm without any gaps in the garment which can cause a reduction in the pressure • A shoulder flap can be added to this garment to prevent slipping down
Interdigital Web Spacer
0536
• To be worn over a glove • To add extra pressure to the highest point of the web spaces between the digits only Note: Usually, the glove alone will give adequate pressure. It is recommended to use slant inserts. See modifications.
38
Garment Styles
Design Choices
Modifications
Measuring Guide
Glove to Elbow
0534
For scarring to: • Hand and forearm Note: Use the Jobskin blue tape to take measurements if the glove is required beyond wrist.
Mitten
0537
• Indicated for total loss of the digits or where digits cannot go into finger stalls of a conventional glove
Individual Finger
0025
• Give the PIP and the DIP circumference measurements, and the length required
39
Garment Styles
Design Choices
Modifications
Please consider the following: • In order to apply adequate pressure the glove should be constructed to one joint beyond the distal margin of the scar area. • Consider both sides of the hand when determining the style required by carefully examining to determine the distal end of the scarring of the entire hand on both the distal and palmar surface. Glove with open fingertips at the PIP level (this recommended for tactile sensation) • If the scarring extends to the level of the MCP joint, a glove with the fingertips to the PIP joint should be ordered. • If the scarring extends beyond the distal portion of the metacarpal head, this style will not apply adequate pressure, therefore the glove should be ordered to the DIP joints. Glove with open fingertips at the DIP level For scarring to: • Extending to the level of the proximal portion of the middle phalanx, the glove can be constructed to the end at the DIP joint level. • This style is preferred over the closed fingertips, because the open fingertips provide better tactile sensation and use of the hand. Full glove with closed fingertips For scarring to: • Extending to the DIP joints • Later as the scarring begins to mature, the glove can revised with open fingertips. Fingers Fingers can be constructed with a mix of short of long fingers. 40
DIP PIP
Measuring Guide
Garment Styles
Design Choices
Modifications
Measuring Guide
Slant inserts Pocket
0021: Reinforced palm
- Extra pressure to palm, does not cover thumb area. Ideal for manual workers and children where a glove gets a lot of wear
Zippers
- Standard location is ulnar side but may be placed on the dorsal or palmer also. - Selected for ease of fitting or for the insertion of conformers. Note: avoid zippers if possible as pressure can be compromised
0027: Pockets
- Sewn in for the insertion of pads to apply extra pressure to certain areas.
0069: Slant Inserts
- Select when pressure is required into the web spaces of the hand, not thumb. - A seam is sewn between the digits to provide pressure to the web spaces. - This style is recommended for all scarring to the web spaces.
Garment Styles
Design Choices
Modifications
Tools required • • • • • •
Jobskin Data Form - 505 Jobskin finger measuring tape - white Regular measuring tape Straight ruler Inner of a biro or thin pen/pencil If extending up the arm, the Jobskin blue arm tape will be required 41
Measuring Guide
Garment Styles
Design Choices
Modifications
Measuring Guide
Procedure • Seat patient in a comfortable position with the arm extended. • Remove any jewellery or rings. Construction of Jobskin finger measuring tape • Make up tape as follows and as illustrated choosing either inches or centimetres, secure back with tape. • Read measure off from top of tape, recording the first clear measure you see in the window, if it falls between read off the largest measurement. Measuring the hand using a hand outline tracing • You may provide the linear measurements (12- 20) of the hand required using a hand outline drawing which can be done on a plain sheet of paper. As follows: 14 13
12
18
15
13
12
16
16 17
14
If the glove is to have open finger tips, mark the desired ends of the fingers on the tracing (like this) and then measure the desired finished lengh.
15
19
19
18
17
20
20
Wrist crease
W rist crease
Left Dorsal View
Right Dorsal View
• Place the patients hand on a blank page with fingers and thumb slightly spread • Measure with a ruler from the highest point of the thumb web and finger webs along the inner aspect of each digit to the end of the digit or the desired finished lengths of each digit. • You will also need to measure from the wrist crease to the highest point of each finger web space. • If contractures are present you may not be able to use this method, lengths will need to be taken using a pipe cleaner or a piece of string or a flexible ruler. • Please mark on this the patients name and date and send with your Order Form and measurement data form. 42
Garment Styles
Design Choices
Modifications
Key: • Orange = Circumference measurements • Black = Lengths measurements
Measuring Guide
5
7
3 6
8
4
1 2
9
10
11
Number Required Measurements Method 1
Little Finger - DIP joint
- Measure around each DIP and PIP joint of each digit using Jobskin paper tape measure. Note: Ensure that the tape is as firm as possible, but you must still be able to move the tape round the joint. - Only measure the digits required to be incorporated into glove and the corresponding DIP and PIP measures necessary
2
LF PIP
3
RF DIP
4
RF PIP
5
MF DIP
6
MF PIP
7
IF DIP
8
IF PIP
9
Thump IP
10
Palm
Using the finger tape, widen the loop and place it around the palm (thumb excluded). It is usually best if you can get your patient to lay their hand flat (If possible) and feed the tape into the palm web. Note: Do not pull the tape tight.
11
Wrist
Place the loop around the wrist between the Ulnar Styloid Process and the base of the hand and read off the measurements in the tape window. Tip: leave the tape in place around the wrist and measure the lengths. 43
Garment Styles
Design Choices
Modifications
Key: • Orange = Circumference measurements • Black = Lengths measurements
13
Measuring Guide
14 15
12
16
17
Number Required Measurements 12
Little finger
13
Ring finger
14
Middle finger
15
Index finger
16
Thumb
17
Wrist to between lf and RF
18
Wrist to between MF and RF
19
Wrist to between IF and MF
20
Wrist to thumb web
18
19
20
Method - Measurements 12 - 20 are linear and should be taken on the back of the hand or taken from a hand outline tracing - Measure the length of the digit from the highest point of the web to the finger tips or the required finished length. Or transfer lengths from hand drawing method. - If it is not possible, or awkward to measure the lengths with a tape measure use a piece of string/pipe cleaner
Measure from the wrist crease to the web spaces for measurements 17 - 20
Mitten to wrist Repeat measurements as for the glove, except if the fingers are contracted or are too short or absent, then draw an outline around the stump and give the width measurements. Measure the circumference around the top of the stump. 44
Lower Extremity section Garment Styles Modifications Measuring Guide Jobskin Data Form - 506 and 508
Lower Extremity
Design Choices
Garment Styles
Design Choices
Modifications
Measuring Guide
0105
Anklet Anklet: For scarring to: • Below malleolus, not extending to MTP joints • Can be open or enclosed for toes • Consider adding a heel lining to prolong life of the garment • This design is comfortable but consider scar areas carefully so you do not compromise pressure to the required scar area. Make sure garment is 5cm beyond scar area.
Knee Length
0101
For scarring to: • Lower leg and foot • Scar should not extend beyond the upper one third of the lower leg • If scarring extends to the patella or poplitealfossa region – use a full length leg garment as pressure will be compromised • Open or closed toe styles available
Thigh Length
0201
For scarring to: • To lower thigh, patella and lower leg • Silicone elastic can be selected to hold the garment up • Open or closed toes available • Zippers may be incorporated into garment if required, however pressure may be slightly compromised • Consider a chap style one leg as an alternative to prevent garment falling down 47
Garment Styles
Design Choices
Modifications
Chap Style, with Waistband, One Leg Chap Style, with Waistband, Two Legs
Measuring Guide
0035 0036
For scarring to: • As per thigh length, 0201, but with the addition of a waist band to secure and hold in place.
0538 0539
Foot Glove to Ankle Foot Glove to Knee For scarring to: • Into the MTP JT’s, toe webs and individual toes • Please ensure patient keeps toe nails short, please consider length of these when measuring • For the 0539 use orange tape for leg measurements A sock with individual toes applying pressure to these area’s.
Waist Height, Two Legs, Open Pubis Waist Height, Two Legs, Closed Pubis For scarring to: • To both entire lower extremities, • If they have been used as donor sites, a garment with bilateral full length legs is suggested. Note: Scar tissue will mature at a different rate in different areas of the body, this style of garment will probably require revision before the entire leg is mature. 48
1102 1101
Garment Styles
Design Choices
Modifications
Waist Height, One Legs, Open Pubis
Measuring Guide
1103
For scarring to: • Lower abdomen, hips and one leg. Will not address abdomen scarring therefore consider a panty with short leg
Chest Height, Two Legs, Pregnancy
1104
• A reduced pressure panel over the abdomen, which is suitable for pregnant women
1122 1119
Panty Girdle, Open Pubis Panty Girdle, Closed Pubis For scarring: • Over the hip joint or the upper thigh • This type of garment will assure proper pressure overthe hip and upper thigh that would be lacking in the panty brief. • To achieve adequate pressure, the scar should not extend any further than 3” (7.62cm) above the knee. • Can be constructed with legs of differing lengths and an open or closed pubis. 49
Garment Styles
Design Choices
Modifications
Measuring Guide
Panty Girdle (below Knee) Open Pubis Panty Girdle (below Knee) Closed Pubis
1110 1111
Waist Height, One Leg, Panty, Open Pubis Waist Height, One Leg, Panty, Closed Pubis
1112 1113
The waist height with one full length leg and the other a short leg For scarring: • Over the lower abdomen in addition to one entire leg • If restricted to the thigh of one leg and the entire length of the opposite leg Note: consider patients lifestyle, mobility and age when ordering this style.
1120
Panty Brief, Closed Pubis For scarring to: • To buttocks or pelvic area • This type of garment should not be used if the burn extends beyond the hip joint or the fold of the buttocks.
50
Garment Styles
Design Choices
Modifications
Measuring Guide
Stump The stump support is measured with the red full length measuring tape, please see diagram.
Waist Height, One Stump Waist Height, Two Stumps
1132 1133
Waist Height, One Leg plus Stump, Closed Pubis Waist Height, One Leg plus Stump, Open Pubis
1134 1135
51
Garment Styles
Design Choices
Modifications
Measuring Guide
Male style openings Horizontal fly opening: • A standard opening and will provide some pressure over the genital area Diagonal fly opening • Standard design is lining • If more pressure is required over the genital area this style of opening is recommended as it fits more snugly, if made in Powerner fabric
Garment Styles
Design Choices
Modifications
0012: Double waistband
- Two layers of elastic to reinforce
0024: Reinforced top of waist
- Reinforced with lining
0040: Behind the knee lining
- Soft material lining the garment to prevent pinching at the back of the knee
1159: Self enclosed toes
- Enclosed with powernet fabric in one piece, no seams
0020: Extra heel reinforcement
- For high wear area to reinforce
0027: Pockets
- Pockets made of soft material. Open to insert padding to give extra pressure in difficult areas
1175: Double - Used to give extra support to a pendulous abdomen or collapsed abdominal panel stomach muscles, usually used in conjunction with an uplift panel 1176: Uplift panel
- Extra pressure panel over abdomen to help hold up collapsed muscles in the stomach
1184: Reinforced top of thigh
- A lining used to reinforce the garment, the lining is usually 5cm (2”) wide, but can be made wider if requested. 52
Garment Styles
Design Choices
Modifications
Measuring Guide
Suspenders/braces Double abdominal panel Reduced pressure abdominal panel
Reinforced top of thigh
Reinforced knee
Reinforced heel Soft enclosed toe
1160: Soft enclosed toe
- Soft lining fabric used
1164: Zipper under 20cm 1165: Zipper over 20cm
- Scars which are fragile or unhealed in small areas, or if the patient has limited hand function, long or short zippers can be used. - Short zippers can be inserted at the waist or the ankle to ease the fitting of the garment. - If you require zippers on the body only, these can be placed right or left of the front center seam form groin to waist - We can also place zippers in the front centre seam
1161: Reduced pressure abdominal panel
- Reduced pressure over the abdomen area for patients who cannot tolerate pressure on the abdomen. Made out of soft material
1162: Attach suspenders
- Suspenders (braces) are used, especially with children, to hold up the garment
1185: Reinforced inner - If the patient is overweight and the thighs meet together, the inner thigh and perineum thigh and perineum are reinforced to prolong the life of the garment. 1186: Reinforced knee
- Lining at the front of the knee to strengthen the knee area
1187: Reinforced heel 1163: Velcro tabs
- To attach waist height to vest. 53
Garment Styles
Design Choices
Modifications
Measuring Guide
Tools required • • • • • • • •
Jobskin Data Form - 506 and 508 (foot glove) Jobskin measuring tape - full length - coloured red Jobskin measuring tape - knee length - coloured orange Regular measuring tape Sheet of blank paper for foot drawing Inner of a biro or thin pen/pencil Measuring stand Adhesive tape
Procedure Full Length Take measurements while patient is lying down or semi-prone with the leg elevated on the Jobskin measuring stand and foot in a normal relaxed position. The ankle should be resting on the measuring stand. Label the tape with the patients name and whether right of left leg. Note: if you have a patient whose extremity is large and the circumference straps will not accommodate the size, extend their length by either using supplied 'extension' straps or adding another strap to lengthen, the 'extension' straps are numbered in sequence. Add and secure so that the numbering sequence is unbroken. If another 'strap' is added, secure to the attached strap with the plain (unnumbered) side facing up. Do not cut the extended straps short. Leave the extended straps intact, so the exact length can be determined. If you are transferring the measurements to the order form, then use a regular measuring tape (and measure from one end to the other).
Pleating - The tape (orange or red) may be pleated only at the top (below the knee or thigh) or bottom (base of the great toe). - If a strap does not fall exactly at the correct position to end the garment, then fold the next strap back until it is in position to wrap around the foot or leg. - Secure these two straps along the spine of the tape with adhesive tape. - Read the measurements where the strap intersects the orange/red spine along the straight edge. Transfer these onto the Jobskin Data Form - 506 - Remember to measure the distance between the centre lines of the pleated straps and fill in the appropriate box on the form. 54
Garment Styles
Letter
Design Choices
Modifications
Measuring Guide
Full Length Method
A
- Place the horizontal spine of the measuring tape (red) along the top of the leg. - The strap marked 'heel' ('0') should be directly over the bend of the instep. - Wrap the strap marked 'heel' ('0') around the highest point of the heel and fasten it to the self-adhesive tabs, (secure with adhesive tape). - This measurement is critical in determining the length of the support. - Use (orange) knee length tape for children.
B
At the foot end of the tape, wrap each succeeding tape around the foot, proceeding from the instep to the base of the toes.
C
Proceed from the heel '0' strap up to leg, fastening all straps securely to the self adhesive tabs and then secure with adhesive tape. Wrap the circumferential straps around the limb firmly, but do not allow skin to bulge between the straps by pulling too tightly. The correct counter pressure will be built into the garment. When measuring an obese or oedeamatous patient, it may be necessary to lift up the hanging flesh and pull the tapes a little tighter; therefore in this instance there will be some bulging of skin between the tapes.
D
Make sure all the circumferential straps are securely fastened and remove measuring tapes by cutting on the scalloped side of the horizontal spine. These straps may be cut short except for any extensions.
E
Fold the completed tape and send with your completed paperwork, or read off the measurements on the tape, reading along the straight edge of the spine and transfer the measurements onto the matching tape diagram on the order form, see pleating.
Note: Remember to measure the length of the foot if you require a closed foot and enter it onto the Jobskin Data Form or make a drawing of the foot. Stand the patient on a blank sheet of paper and with the inner of a biro or thin pen/pencil carefully draw around the whole foot. Indicate on drawing whether left or right. Make sure that you keep the pen/pencil perpendicular to the paper whilst making the drawing. 55
Garment Styles
Design Choices
Modifications
Measuring Guide
Waist Height Having measured the leg, or legs, it is now necessary to measure for the waist height section of the garment. Measure circumferences at the points indicated by the arrows indicated on order form - 506. • Measure all heights form the floor without shoes • It is important that all heights are accurate • All linear measurements taken from the back of the patients are to be taken with the patient standing. If the patient cannot stand, lay them down on their side. Number
Waist Height Circumferential measurements
1
Top of support
3
Waist
5
Hips
7
Largest part of buttocks
9
Left - Inner thigh - make sure the tape is not angled
1 3 5 7 9
10 2 4 6 8
Number
Waist Height Vertical measurements
11
2
Required top of support to floor
4
Waist to floor
6
Hips to floor
8
Largest part of buttocks to floor
11
When taking measurement 11 tuck the tape well in under the gleuteal fold. If the patient is obese lift the buttocks to get the correct length. - If the patient is pregnant or has a protruding stomach, then measurements 1 and 2 will be required. State the month of pregnancy at the time of measuring, on the Jobskin Data Form - 506. Tip: take circumference and length simultaneously.
Note: if the patient has a contracture of the knee, you cannot gain accurate measurements from the floor up, you must follow the lines of the body - Note on the Jobskin Data Form - 506 that you have done this. Short Leg When you require a short leg on a waist height always use the full length tale (red) using only as many straps as necessary anchoring at the heel. 56
Garment Styles
Design Choices
Modifications
Measuring Guide
Knee Length Take measurements while patient is lying down or semi-prone with the leg elevated on the Jobskin measuring stand and the foot in a normal relaxed position. The ankle should be resting on the measuring stand. Label the tape with the patients name and whether left or right leg. Letter
Knee Length Method
A
- Place the horizontal spine of the measuring tape (orange) along the top of the leg so that the strap marked 'heel' ('0') is directly over the bend of the instep. - Then wrap the strap marked 'heel' ('0') around the highest point of the heel and fasten it to the self-adhesive tabs, (secure with adhesive tape). - This measurement is critical in determining the length of the support and it is, therefore, important that the strap be positioned correctly.
B
At the foot end of the tape, wrap each succeeding tape around the foot, proceeding from the instep to the base of the toes using the self adhesive tabs and secure with adhesive tape.
C
- Proceed form the heel ‘0’ strap up to leg, fastening all straps securely to the self adhesive tabs and then secure with adhesive tape. - Wrap the circumferential straps around the limb firmly, but do not allow skin to bulge between the straps by pulling too tightly. - The correct counter pressure will be built into the garment. - When measuring an obese or oedematous patient, it may be necessary to lift up the hanging flesh and pull the tapes a little tighter; therefore there will be some bulging of skin between the tapes. - The last strap should be approximately 3.8cm (11/2�) below the bend of the knee.
D
Make sure all the circumferential straps are securely fastened and remove measuring tapes by cutting on the scalloped side of the horizontal spine. These straps may be cut short except for any extensions.
E
Fold the completed tape and send with your completed paperwork, or read off the measurements on the tape, reading along the straight edge of the spine and transfer the measurements onto the matching tape diagram on the order form, see pleating page 54.
57
Garment Styles
Design Choices
Modifications
Measuring Guide
Foot Glove Take measurements while patient is lying down or semi-prone with the leg elevated on the Jobskin measuring stand and the foot in a normal relaxed position. Do a drawing of the foot, marking left or right and patients name. Stand the patient on a blank sheet of paper and with the inner of a biro or thin pen/pencil carefully draw around the whole foot. Indicate on drawing whether left or right. Make sure that you keep the pen/pencil in a straight, upright position whilst making the drawing, making sure that the pen/pencil passes between each of the toes into the web spaces. If the foot is contracted measure the length of the foot, if this is difficult, take the measurement from the foot drawing.
Letter
Foot Glove Method
A
Measure the length and circumference of the I.P. joints of each toe using the finger tape.
B
- Place the horizontal spine of the measuring tape (orange) along the leg so that the strap marked 'heel' ('0') is directly over the bend of the instep. - Then wrap the strap marked 'heel' ('0') around the highest point of the heel and fasten it to the self-adhesive tabs, (secure with adhesive tape). - This measurement is critical in determining the length of the support.
C
At the foot end of the tape, wrap each succeeding tape around the foot, proceeding from the instep to the base of the toes.
D
Indicate open or closed toes. It is possible to mix open and closed.
If it not possible to clearly outline the toe webs, measure along the side of each toe from web to toe tip to obtain the length of the toes. The foot glove is designed to give pressure in between the toes. The garment ends at the level of the ankle, but can be extended up the leg to the knee as required.
58
Jobskin Customer Service Please contact our customer service team in Ireland for advice or assistance with your orders: Jobskin Ltd Unit C3, Innovation Works, Tipperary Technology Park, Thurles, Co. Tipperary Ireland t: 00 353 504 22166 f: 00353 504 22735 e: ireorders@jobskin.ie w:www.jobskin.co.uk
All rights reserved. No part of this publication may be reproduced without prior permission of Jobskin Ltd 59
Jobskin Ltd Unit 13a Harrington Mill Leopold Street Long Eaton Nottingham NG10 4QG
www.jobskin.co.uk