No abstract

Use of a prosthesis in lower limb amputees can lead to skin problems of the amputation stump. However, little is known about the epidemiology and type of problems experienced. We conducted a cross-sectional survey consisting of a questionnaire and a clinical assessment of the amputation stump. The aims of the study were to estimate the prevalence of skin problems of the amputation stump, to evaluate the impact of these skin problems and to evaluate differences between clinically observed skin problems and skin problems reported by the amputee. Participants (n = 124) were recruited from among lower limb amputees who visited an orthopaedic workshop. The prevalence of skin problems was 36%. Problems identified were: reduction in prosthesis use, and reduction in walking distance without a break. Significantly more skin problems were reported than observed (p = 0.011). Cold skin and excessive perspiration in particular were significantly more reported than observed. Key words: skin problems; lower limb amputees; questionnaire; sampling study. Skin problems of the stump in lower limb amputees are observed frequently in clinical practice. These skin problems include mechanically-induced problems (e.g. epidermoid cysts, calluses, and verrucous hyperplasia), allergic reactions (e.g. stump oedema, eczema, allergic contact dermatitis, and rash), and bacterial of fungal infections (1, 2). However, epidemiological data concerning the incidence and prevalence of skin problems of the stump in lower limb amputees is limited (3).In a previous study we assessed skin problems in lower limb amputees by means of a questionnaire. The main purpose of that study was to explore determinants for skin problems of the stump in lower limb amputees (4). Older age, male gender, and peripheral arterial disease and/or diabetes as reason for amputation were determinants that decreased the odds of having a skin problem of the amputation stump; whereas smoking, use of anti-bacterial soap, and a high frequency of washing the stump increased the odds of having a skin problem of the amputation stump. Due to the design of this study (a cross-sectional survey by means of a postal questionnaire), it was not possible to verify the skin problems reported by the participants. The estimated prevalence of skin problems of the stump found in this study was 63% (95% confidence interval (CI), 60-67%) (4). This prevalence is in contrast to another study (based on a retrospective chart review) in which a prevalence of 41% (95% CI, 37-44%) was found in the study population. Amputation level, being employed, type of walking aid, and the absence of peripheral vascular disease (as co-morbidity) were identified as determinants that increased the odds of having a skin problem of the amputation stump (5).However, concerning these found prevalences, both studies have their limitations in study methodology (in both studies skin problems were not clinically assessed) (4, 5).The main goal of this study was therefore to estimate the prevalence of skin problems of the stump i...

Prevalence and incidence of skin problems of the stump in lower limb amputees are mainly unknown.

The aim of this study was to analyse the influence of stump skin problems on functioning in daily life in lower-limb amputees. A cross-sectional study was performed by means of a questionnaire containing 9 questions assessing functioning in daily life. Question scores were added to give a total score (range 0 (no influence) to 27 (maximum negative influence)). Two thousand and thirty-nine people were invited to participate, with 805 participants completing a questionnaire. Of these, 507 reported one or more skin problems. Skin problems had a negative influence on ability to perform household tasks, prosthesis use, social functioning, and participation in sports. The mean total score was 5.5 ± 4.1. This correlated significantly with the number of skin complaints (r = 0.483; p = 0.01). In linear regression analyses, gender (β = -0.15) and number of skin problems (β = 0.25) accounted for 23% of the total score. This study confirms the influence of skin problems on functioning in daily life.