Skin problems in lower limb amputees: A systematic review

Meulenbelt, Henk E. J.; Dijkstra, Pieter U.; Jonkman, Marcel F.; Geertzen, Joannes

doi:10.1080/09638280500277032

Cited by 69 publications

(50 citation statements)

References 26 publications

(10 reference statements)

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“…Participants reported that skin problems interfere with good prosthetic device and socket fit and increased the frequency of reported pain. Skin issues are reported in other studies of people with limb loss [34,[62][63][64][65][66][67][68]. Dillingham et al reported a 25 percent prevalence of skin and wound problems among community-based participants with trauma-related limb loss [69].…”

Section: Discussionmentioning

confidence: 84%

Servicemembers and veterans with major traumatic limb loss from Vietnam war and OIF/OEF conflicts: Survey methods, participants, and summary findings

Reiber¹,

McFarland²,

Hubbard³

et al. 2010

JRRD

159

167

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Abstract-Care of veterans and servicemembers with major traumatic limb loss from combat theaters is one of the highest priorities of the Department of Veteran Affairs. We achieved a 62% response rate in our Survey for Prosthetic Use from 298 Vietnam war veterans and 283 servicemembers/veterans from Operation Iraqi Freedom/Operation Enduring Freedom (OIF/ OEF) who sustained major traumatic limb loss. Participants reported their combat injuries; health status; quality of life; and prosthetic device use, function, rejection, and satisfaction. Despite the serious injuries experienced, health status was rated excellent, very good, or good by 70.7% of Vietnam war and 85.5% of OIF/OEF survey participants. However, many health issues persist for Vietnam war and OIF/OEF survey participants (respectively): phantom limb pain (72.2%/76.0%), chronic back pain (36.2%/42.1%), residual-limb pain (48.3%/ 62.9%), prosthesis-related skin problems (51.0%/58.0%), hearing loss (47.0%/47.0%), traumatic brain injury (3.4%/33.9%), depression (24.5%/24.0%), and posttraumatic stress disorder (37.6%/58.7%). Prosthetic devices are currently used by 78.2% of Vietnam war and 90.5% of OIF/OEF survey participants to improve function and mobility. On average, the annual rate for prosthetic device receipt is 10.7-fold higher for OIF/OEF than for Vietnam war survey participants. Findings from this crossconflict survey identify many strengths in prosthetic rehabilitation for those with limb loss and several areas for future attention.

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Section: Discussionmentioning

confidence: 84%

Servicemembers and veterans with major traumatic limb loss from Vietnam war and OIF/OEF conflicts: Survey methods, participants, and summary findings

Reiber¹,

McFarland²,

Hubbard³

et al. 2010

JRRD

159

167

View full text Add to dashboard Cite

show abstract

“…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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“…3,19 Poor suspension has negative effects on the residual limb skin, amputee's gait and comfort levels. [20][21][22][23][24][25][26][27] Researchers have been working on the development of new suspension systems that can increase the options available to clinicians. 4,[28][29] The ability to measure pistoning helps when evaluating the quality of a suspension system in a lower limb prosthesis.…”

mentioning

confidence: 99%

Pistoning assessment in lower limb prosthetic sockets

Eshraghi

Osman²,

Gholizadeh³

et al. 2012

Prosthetics &Amp; Orthotics International

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Background: One of the main indicators of the suspension system efficiency in lower limb prostheses is vertical displacement or pistoning within the socket. Decreasing pistoning and introducing an effective system for evaluating pistoning could contribute to the amputees’ rehabilitation process.Objectives: The main objective of this study was to review existing research studies that examine the occurrence of pistoning in lower limb prosthesis with different techniques in static (standing) and dynamic (walking and jumping) positions.Study Design: Literature review.Methods: Keywords related to slippage, suspension, pistoning and vertical movement in lower limb prosthetics were used to search the literature available in PubMed, ScienceDirect, Web of Science and Google Scholar databases. Sixteen articles were selected for further analysis according to the selection criteria.Results: The following methods have been used to measure the occurrence of pistoning in prosthetic limbs: radiological methods, photographic technique, motion analysis system, sensor and spiral computerized tomography (CT). Pistoning was measured both in standing and walking.Conclusions: The results of this review reveal that further research is needed to develop and evaluate easy, accurate and safe methods of measuring pistoning. Future studies should provide a gold standard for the acceptable range of pistoning in a prosthetic socket.Clinical relevanceThis literature review contributes to a further understanding of lower limb prosthetic biomechanics by highlighting the strengths and weaknesses of the techniques that are currently available for evaluating the occurrence of pistoning in a prosthetic socket. It provides a useful overview of the current methods of measuring residual limb movements relative to the socket and liner, and will be of use for both practitioners and researchers in prosthetics and orthotics fields.

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Skin problems in lower limb amputees: A systematic review

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

Cited by 69 publications

References 26 publications

Servicemembers and veterans with major traumatic limb loss from Vietnam war and OIF/OEF conflicts: Survey methods, participants, and summary findings

Servicemembers and veterans with major traumatic limb loss from Vietnam war and OIF/OEF conflicts: Survey methods, participants, and summary findings

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

Pistoning assessment in lower limb prosthetic sockets

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