Skin Problems of the Stump in Lower-limb Amputees: 2. Influence on Functioning in Daily Life

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

doi:10.2340/00015555-1023

Cited by 41 publications

(30 citation statements)

References 102 publications

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“…[2][3][4][5] Currently, there is a lack of knowledge surrounding the effects of the prosthetic socket interface on the health of the residual limb. The current work describes a standardized approach to measure salient residual limb skin health outcomes.…”

Section: Clinical Problem Addressedmentioning

confidence: 99%

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Standardized Approach to Quantitatively Measure Residual Limb Skin Health in Individuals with Lower Limb Amputation

Rink

Wernke

Powell

et al. 2017

Advances in Wound Care

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Objective: (1) Develop a standardized approach to quantitatively measure residual limb skin health. (2) Report reference residual limb skin health values in people with transtibial and transfemoral amputation. Approach: Residual limb health outcomes in individuals with transtibial (n = 5) and transfemoral (n = 5) amputation were compared to able-limb controls (n = 4) using noninvasive imaging (hyperspectral imaging and laser speckle flowmetry) and probe-based approaches (laser doppler flowmetry, transcutaneous oxygen, transepidermal water loss, surface electrical capacitance). Results: A standardized methodology that employs noninvasive imaging and probebased approaches to measure residual limb skin health are described. Compared to able-limb controls, individuals with transtibial and transfemoral amputation have significantly lower transcutaneous oxygen tension, higher transepidermal water loss, and higher surface electrical capacitance in the residual limb. Innovation: Residual limb health as a critical component of prosthesis rehabilitation for individuals with lower limb amputation is understudied in part due to a lack of clinical measures. Here, we present a standardized approach to measure residual limb health in people with transtibial and transfemoral amputation. Conclusion: Technology advances in noninvasive imaging and probe-based measures are leveraged to develop a standardized approach to quantitatively measure residual limb health in individuals with lower limb loss. Compared to able-limb controls, resting residual limb physiology in people that have had transfemoral or transtibial amputation is characterized by lower transcutaneous oxygen tension and poorer skin barrier function.

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Section: Clinical Problem Addressedmentioning

confidence: 99%

“…1 This leads to a high incidence of skin-related health problems for individuals with lower limb loss, [2][3][4][5] including irritation, swelling, blisters, abrasions, corn/callus formation, and ulceration. In extreme cases where residual limb wounds do not heal, surgical revision of the amputation may be required.…”

Section: Introductionmentioning

confidence: 99%

Standardized Approach to Quantitatively Measure Residual Limb Skin Health in Individuals with Lower Limb Amputation

Rink

Wernke

Powell

et al. 2017

Advances in Wound Care

View full text Add to dashboard Cite

show abstract

“…Quality of life for people with amputation is partly dependent on the successful use of a prosthetic device [2][3][4]. The skin-socket interface plays a vital role in determining this success, and residual-limb skin problems have been shown to have a negative effect on prosthetic use [5] and ability to perform activities of daily living (ADLs) [6], as well as quality of life [7]. Excessive sweating, or hyperhidrosis, was the single most reported skin problem in a survey of people with lower-limb amputation [8]; the overall incidence has been estimated at 66 percent [9].…”

Section: Introductionmentioning

confidence: 99%

Incidence, severity, and impact of hyperhidrosis in people with lower-limb amputation

et al. 2015

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Abstract-To assess the incidence and severity of selfreported hyperhidrosis in patients with amputation and understand its effects on prosthetic fit or function, a cross-sectional survey of patients at two amputee clinics was performed.Responses from 121 subjects with lower-limb amputation were analyzed. Of these subjects, 66% reported sweating to a degree that it interfered with daily activities, as measured by the Hyperhidrosis Disease Severity Scale. There was a significant association between sweating and interference with prosthetic fit and function. Sweating was more severe in cases of transtibial amputations, patients under the age of 60 yr, warm weather, and vigorous activity. There was no relationship between severity of sweating and time since amputation, etiology of amputation, duration of daily prosthetic use, or reported ability to perform functional tasks. Subjects reported trying multiple interventions, but the self-reported effectiveness of these treatments was low. Hyperhidrosis, a common problem associated with prosthetic usage, varies in severity and often interferes with daily activities. Sweating severity is associated with poor prosthetic fit and function. Risk factors include younger age and transtibial amputation status. Treatment strategies generally lack efficacy. The results of this study may provide guidance for future interventions and treatment options.

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“…People with lower-limb amputation often complain about uncomfortable residual-limb skin temperatures and the accumulation of perspiration within their prostheses [1][2][3][4][5][6]. Even short bouts of walking can cause substantial increases in residual-limb skin temperatures [7][8] and result in cumulative increases throughout the course of a typical day [9].…”

Section: Introductionmentioning

confidence: 99%

Prosthesis management of residual-limb perspiration with subatmospheric vacuum pressure

et al. 2016

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Abstract-For the ambulatory person with lower-limb amputation, insufficient management of perspiration can result in inadequate prosthesis adherence, reduced mobility, and discomfort. This study compared a dynamic air exchange (DAE) prosthesis designed to expel accumulated perspiration with a total surface bearing suction socket (Suction) that cannot. Five people with unilateral transtibial amputation participated in a randomized, crossover experiment. All subjects were given a 1 wk acclimation period to each study prosthesis while we measured their step activity levels. A rest-walk-rest protocol, including a 30 min treadmill walk at a self-selected speed while wearing thermally insulative garments, was then used to observe residual-limb skin temperatures and perspiration. Afterward, subject opinions about the prostheses were assessed with questionnaires. During the weeklong acclimation period, no statistical difference in step activity levels were detected between prostheses (p = 0.22), but this may have been due to self-reported behavioral modifications. During the rest-walkrest protocol, no differences in skin temperatures were observed (p = 0.37). The DAE prosthesis accumulated 1.09 +/-0.90 g and expelled 0.67 +/-0.38 g of perspiration, while the Suction prosthesis accumulated 0.97 +/-0.75 g. The questionnaire results suggest that participants were receptive to both prostheses. The DAE prosthesis was able to expel more than a third of the total perspiration, suggesting it may enable longer uninterrupted periods of perspiration-inducing activity.

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Skin Problems of the Stump in Lower-limb Amputees: 2. Influence on Functioning in Daily Life

Cited by 41 publications

References 102 publications

Standardized Approach to Quantitatively Measure Residual Limb Skin Health in Individuals with Lower Limb Amputation

Standardized Approach to Quantitatively Measure Residual Limb Skin Health in Individuals with Lower Limb Amputation

Incidence, severity, and impact of hyperhidrosis in people with lower-limb amputation

Prosthesis management of residual-limb perspiration with subatmospheric vacuum pressure

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