Skin Problems in an Amputee Clinic

Dudek, Nancy; Marks, Meridith; Marshall, Shawn

doi:10.1097/01.phm.0000214272.01147.5a

Cited by 49 publications

(33 citation statements)

References 8 publications

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“…4,5 ITAPs would allow for direct anchoring to the bone, thus potentially overcoming these problems. However, limited success has been seen in such devices in amputees.…”

Section: Discussionmentioning

confidence: 99%

“…Such a design results in the nonuniform distribution of pressure and can lead to pain, infection, and necrosis of the soft tissues at the point of contact. 4,5 It is believed that intraosseous transcutaneous amputation prostheses (ITAPs) can overcome these issues by directly attaching the implant to the skeleton through transcutaneous abutment. 6 Transcutaneous implants have been used clinically since the 1960s.…”

Section: Introductionmentioning

confidence: 99%

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Engineering a Titanium and Polycaprolactone Construct for a Biocompatible Interface Between the Body and Artificial Limb

Smith

Roy

Bhalkikar

et al. 2010

Tissue Engineering Part A

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Intraosseous transcutaneous amputation prostheses may be able to overcome the problems that stem from the nonuniform distribution of pressure seen in the conventional stump-socket prosthetic replacement devices. Transcutaneous devices have had limited success in amputees. By optimizing the attachment of the skin to the prosthetic, intraosseous transcutaneous amputation prostheses may become clinically viable options. This report details studies evaluating the development of a modified titanium construct with a specially machined surface to increase the adherence of tissue as well as scaffold. A computer-aided biology tool was used to fabricate polycaprolactone (PCL) scaffolds with a specific three-dimensional architecture. To extrude the PCL, it was dissolved in acetic acid to produce a 70% PCL liquid. A scaffold with a porosity of >50% was fabricated to have a tensile strength similar to skin. The presence of a specially machined surface greatly increased the adhesion of the PCL scaffold to the titanium constructs. When the 70% PCL was properly neutralized by heating at 55 degrees C and washing in 90% ethanol (EtOH), there was only a decrease (10%) in the viability of cells seeded onto the PCL constructs when compared with the cells in culture. The antibacterial properties of titanium dioxide anatase, silver nanoparticles, and chlorhexidine diacetate mixed in either type I collagen or hyaluronic acid (HA) were assessed. The addition of 1% (w/w) chlorhexidine diacetate in HA resulted in a 71% decrease in bacteria seen in nontreated HA. These results show promise in developing a novel engineered titanium and PCL construct that promotes effective adhesion between the titanium-skin interface.

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“…4,5 ITAPs would allow for direct anchoring to the bone, thus potentially overcoming these problems. However, limited success has been seen in such devices in amputees.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Engineering a Titanium and Polycaprolactone Construct for a Biocompatible Interface Between the Body and Artificial Limb

Smith

Roy

Bhalkikar

et al. 2010

Tissue Engineering Part A

View full text Add to dashboard Cite

show abstract

“…A sock log was used in this study to quantify patterns of sock use among persons with transtibial amputation. More precise knowledge of sock use may help practitioners plan volume management strategies, justify socket replacement, or troubleshoot fitting issues, such as skin breakdown, discomfort, or pain (9). Here, we used logs from persons with transtibial amputation to quantify the number of sock changes, sock thicknesses, and times when socks were changed each day.…”

Section: Discussionmentioning

confidence: 99%

“…Patients may be able to generally inform a practitioner about their typical sock use, but specific details may be challenging for patients to recall. Practitioners can also inspect patients’ residual limbs for evidence of prosthetic sock use or misuse (e.g., redness, edema, skin breakdown), but the exact causes of observed issues may be challenging to diagnose (9, 10). Information about how often different prosthetic users change socks, changes in number and thickness of socks worn, and the times of day in which socks are changed could enhance the limb volume management process and aide in troubleshooting poorly fitting sockets.…”

Section: Introductionmentioning

confidence: 99%

Self-reported prosthetic sock use among persons with transtibial amputation

D'Silva

Hafner

Allyn

et al. 2014

Prosthetics &Amp; Orthotics International

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Study design Cross-sectional survey Background Daily changes in the shape and size of the residual limb affect prosthetic socket fit. Prosthetic socks are often added or removed to manage changes in limb volume. Little has been published about how persons with transtibial amputations use socks to manage diurnal changes in volume and comfort. Objectives To investigate prosthetic sock use with a custom, self-report questionnaire. Methods Persons with transtibial amputation reported number, thickness, and timing of socks used over a 14-day period. Results Data from 23 subjects (16M/7F) were included. On average, socks were changed less than once per day (0.6/day) and ply increased over the day (from 4.8ply to 5.5ply). Subjects wore prostheses significantly longer (15.0hrs and 14.1hrs, p=0.02) and changed socks significantly more often (0.6/day and 0.4/day, p=0.03) on weekdays compared to weekends. Participants were also divided into two subgroups: those who used socks to manage limb volume and those who use socks for socket comfort. Sock use did not differ (p>0.05) between subgroups. Conclusions Sock changes are infrequent among persons with lower limb loss. Initial, verbal reports of sock use were often inconsistent with data measured by logs. Tools (e.g., sock logs or objective instruments) to better understand sock use habits among persons with limb loss are needed.

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“…Claudication [4,5] and socket intolerance [6] sometimes remain challenging diagnostic situations. In the present case, due to renal failure, we were reluctant to perform contrast agent injection as a primary tool of proximal ischemia [7].…”

Section: Discussionmentioning

confidence: 99%

Exercise Oxymetry in the Diagnosis of a Clinically Challenging Bilateral Socket Intolerance and Follow-up of An Apparently Inefficient Revascularisation

Henni¹,

Ábrahám²

2017

Int J Phys Med Rehabil

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Socket intolerance is a cause of walking impairment in amputees. Exercise transcutaneous oxygen pressure (ExtcpO 2 ) is proposed to monitor exercise-induced ischemia. A man with bilateral tibial amputation was referred for left thigh pain and socket intolerance. Ex-tcpO 2 showed an ischemia on the left thigh and on buttocks. After vascular surgery, the patient complains from walking limitation with left buttock pain. A new Ex-tcpO 2 showed a normalization of the thighs ischemia but a worsening on the left buttock, due to the circumflex artery occlusion during surgery. This case illustrates questions that physician may face, Ex-tcpO 2 confirms vascular origin of the pain.

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Skin Problems in an Amputee Clinic

Cited by 49 publications

References 8 publications

Engineering a Titanium and Polycaprolactone Construct for a Biocompatible Interface Between the Body and Artificial Limb

Engineering a Titanium and Polycaprolactone Construct for a Biocompatible Interface Between the Body and Artificial Limb

Self-reported prosthetic sock use among persons with transtibial amputation

Exercise Oxymetry in the Diagnosis of a Clinically Challenging Bilateral Socket Intolerance and Follow-up of An Apparently Inefficient Revascularisation

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