Amputation stump: Privileged harbor for infections, tumors, and immune disorders

Buikema, Kathryn E.S.; Meyerle, Jon H

doi:10.1016/j.clindermatol.2014.04.015

Cited by 27 publications

(32 citation statements)

References 25 publications

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“…In amputees the implant is weight bearing and the SPS is more mobile during ambulation and therefore presumably more prone to inflammation. Secondly, after amputation, the skin of the stump is considered to be more fragile and prone to skin problems due to pre‐existing disease and surgical trauma …”

Section: Discussionmentioning

confidence: 99%

“…Secondly, after amputation, the skin of the stump is considered to be more fragile and prone to skin problems due to pre-existing disease and surgical trauma. 24 The stump skin of lower-extremity amputees wearing artificial limbs and complying with satisfactory stump hygiene, harbors a bacterial flora that is considerably more abundant and polymicrobial than that of the contralateral leg. 25 In the present study, the majority of the implants were colonised at the skin exit with various pathogenic bacteria, and variably but frequently along the abutment down into the bone canal.…”

Section: Discussionmentioning

confidence: 99%

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The clinical, radiological, microbiological, and molecular profile of the skin‐penetration site of transfemoral amputees treated with bone‐anchored prostheses

Lennerås

Tsikandylakis

Trobos

et al. 2016

J Biomedical Materials Res

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The breach of the skin barrier is a critical issue associated with the treatment of individuals with transfemoral amputation (TFA) using osseointegrated, percutaneous titanium implants. Thirty TFA patients scheduled for abutment exchange or removal were consecutively enrolled. The aims were to determine the macroscopic skin signs, the presence of bacteria and the gene expression in abutment‐adherent cells and to conduct correlative and comparative analyses between the different parameters. Redness and a granulation ring were present in 47% of the patients. Bacteria were detected in 27/30 patients, commonly in the bone canal. Staphylococcus aureus, coagulase‐negative staphylococci, streptococci, and Enterococcus faecalis were the most common. A positive correlation was found between TNF‐α expression and the detection of S. aureus. Staphylococcus aureus together with other bacterial species revealed a positive relationship with MMP‐8 expression. A negative correlation was demonstrated between the length of the residual femur bone and the detection of a granulation ring and E. faecalis. A positive correlation was revealed between fixture loosening and pain and the radiological detection of endosteal bone resorption. Fixture loosening was also correlated with the reduced expression of interleukin‐10 and osteocalcin. It is concluded that several relationships exist between clinical, radiological, microbiological, and molecular assessments of the percutaneous area of TFAs. Further long term studies on larger patient cohorts are required to determine the precise cause‐effect relationships and unravel the role of host‐bacteria interactions in the skin, bone canal and on the abutment for the longevity of percutaneous implants as treatment of TFA. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 578–589, 2017.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The clinical, radiological, microbiological, and molecular profile of the skin‐penetration site of transfemoral amputees treated with bone‐anchored prostheses

Lennerås

Tsikandylakis

Trobos

et al. 2016

J Biomedical Materials Res

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“…Discomfort commonly results in skin problems and tissue damage (e.g. [10]- [13]). In severe cases when loading conditions cause tissue deformation thresholds to be exceeded (see also [14] on thresholds), painful pressure ulcers may occur [15]; in some reports pressure ulcers have occurred in as high as 55% of subjects with major amputations [16].…”

Section: Introductionmentioning

confidence: 99%

Automated and Data-driven Computational Design of Patient-Specific Biomechanical Interfaces

Moerman¹,

Sengeh²,

Herr³

2016

Preprint

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Abstract-Biomechanical interfaces are mechanical structures that form the connection between a device and a tissue region, and, through appropriate load transfer, aim to minimize tissue discomfort and injury. A patient-specific and data-driven computational framework for the automated design of biomechanical interfaces is presented here. Optimization of the design of biomechanical interfaces is complex since it is affected by the interplay of the geometry and mechanical properties of both the tissue and the interface. The proposed framework is presented for the application of transtibial amputee prostheses where the interface is formed by a prosthetic liner and socket. Conventional socket design and manufacturing is largely artisan, non-standard, and insufficiently data-driven, leading to discrepancies between the quality of sockets produced by different prosthetists. Furthermore, current prosthetic liners are often not patient-specific. The proposed framework involves: A) non-invasive imaging to record patient geometry, B) indentation to assess tissue mechanical properties, C) data-driven and automated creation of patientspecific designs, D) patient-specific finite element analysis (FEA) and design evaluation, and finally E) computer aided manufacturing. Uniquely, the FEA procedure controls both the design and mechanical properties of the devices, and simulates, not only the loading during use, but also the pre-load induced by the donning of both the liner and the socket independently. Through FEA evaluation, detailed information on internal and external tissue loading, which are directly responsible for discomfort and injury, are available. Further, these provide quantitative evidence on the implications of design choices, e.g. : 1) alterations in the design can be used to locally enhance or reduce tissue loading, 2) compliant features can aid in relieving local surface pressure. The proposed methods form a patient-specific, data-driven and repeatable design framework for biomechanical interfaces, and by enabling FEA-based optimization reduces the requirement for repeated patient involvement in the currently manual and iterative design process.

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“…This altered skin, when placed in the socket of a prosthesis, must adapt to a humid environment and withstand the compressive and frictional forces for which it is poorly adapted. These factors and any history of vascular disease, diabetes, or malignancy make stump skin particularly vulnerable to immunologic and tissue breakdown, leading to an area of local immune dysregulation . Neoplasms that may develop include verrucous carcinoma …”

Section: Otherwise Damaged Areasmentioning

confidence: 99%

“…These factors and any history of vascular disease, diabetes, or malignancy make stump skin particularly vulnerable to immunologic and tissue breakdown, leading to an area of local immune dysregulation. 36,68 Neoplasms that may develop include verrucous carcinoma. 69…”

Section: Amputation Stumpmentioning

confidence: 99%

Ruocco's immunocompromised cutaneous district

et al. 2015

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The concept of 'locus minoris resistentiae' (lmr) is an old but still effective way of thinking in Medicine. In Dermatology, there are many reports of privileged localization of cutaneous diseases on injured skin, which therefore represents a typical condition of lmr. Lately the innovative concept of immunocompromised cutaneous district (ICD) has been introduced to explain why a previously injured cutaneous site may become in time a privileged location for the outbreak of opportunistic infections, tumors, and immune reactions. An ample documentation of multifarious disorders (infectious, neoplastic, immune) appearing in ICDs was delineated by Ruocco et al. in 2009. These cases were grouped according to the clinical settings responsible for the local immune imbalance: regional chronic lymphedema; herpes-infected sites, which feature the well-known Wolf's isotopic response; and otherwise damaged areas, comprising sites of vaccination, ionizing or UV radiation, thermal burns, and traumas. In the following five years, what was a "novel" pathogenic concept has been extended to an enlarging variety of clinical conditions. This paper focuses on ICD and the expanding spectrum of this now established pathogenic concept.

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Amputation stump: Privileged harbor for infections, tumors, and immune disorders

Cited by 27 publications

References 25 publications

The clinical, radiological, microbiological, and molecular profile of the skin‐penetration site of transfemoral amputees treated with bone‐anchored prostheses

The clinical, radiological, microbiological, and molecular profile of the skin‐penetration site of transfemoral amputees treated with bone‐anchored prostheses

Automated and Data-driven Computational Design of Patient-Specific Biomechanical Interfaces

Ruocco's immunocompromised cutaneous district

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