Contact the Amputee Coalition at 888/267-5669 or amputee-coalition.org - PDF document

Contact the Amputee Coalition at 888/267-5669 or amputee-coalition.org 41 by M. Jason Highsmith, DPT, CP, FAAOP, James T. Highsmith, MD, and Jason T. Fitting a prosthesis is complicated because parts of the human body are used for tasks for which they are not designed. The skin/prosthesis interface is at fault for many complications. Here, of material contact. Skin problems are affecting lower-limb prosthetic users today. Skin problems are experienced by approximately 75 percent of amputees using a lower-limb prosthesis. In fact, amputees experience nearly 65 percent more dermatological complaints than the conditions are introduced in a prosthesis, Additionally, the skin reacts to increased temperature with closed prosthetic environ-ment. This results in more heat and moisture softening the skin, thereby disrupting Pressure is another mechani-cal issue intro-duced in a prosthetic human anatomy are well-suited to disperse pressure, Identifying and Managing Skin Issues With Lower-Limb Prosthetic Use Figure 1. Bony prominences with decubiti (pressure sores) Figure 2. Figure 3. Irritant contact dermatitis with exco-riation (excessive scratching which breaks the surface of the skin … circled) skin is exposed to a material that creates or allergic component exists in the patients prosthesis, it should be switched to another material. Furthermore, both conditions can be treated with topical steroids or a barrier cream. Several over-the-counter (OTC) topical prepara-tions are available for these conditions, such as hydrocortisone and zinc oxide. Untreated, dermatitis can lead to chronic in”ammation, cellular damage and carci-nogenesis (cancer). Therefore, we urge all 42 in Volume 21, Issue 1 January/February 2011 PhotoDiagnosis History [Signs/Symptoms]Physical Exam FindingsAcute ManagementLong-Term Management Figure 1Pressure sores(Decubitus ulcers)Pain and/or redness over bony prominences Erythema (redness) or ulceration over bony prominences Stop using prosthesisAntibiotic ointment (e.g., Polysporin*) Prosthetic adjustmentFigure 2Allergic Contact First exposure causes no reaction (type IV delayed hypersensitivity reaction)Itching and redness appears 1-5 days after second exposure and aects everywhere the allergen contacts the skinMay extend beyond allergen contact areas if severeAcutely, may have well-demarcated erythema, weeping or blistersSubacutely, erythema, less well-demar-cated, maybe scaly skinChronically, erythema and dry, thick, scaly skinMoisturizerTopical steroids (e.g., hydrocortisone)Allergen avoidance(substitute allergen for materials that do not aggravate symptoms)Figure 3Irritant Contact Itching and redness typically appear immedi-ately after contact (even with rst exposure)Severity related to duration & amount of exposureNever extends beyond contact areaSame as allergic contact dermatitisBarrier cream [zinc oxide]MoisturizerTopical steroids Avoid or minimize irritant exposure (e.g., perspiration from heat or friction)Figure 4Negative Pressure HyperemiaNegative pressure socket, pain and erythema under prosthesis in a well-circumscribed patternUsually a history of limb volume change (i.e., weight gain/loss, edema)Well-demarcated erythema that is exqui-sitely tender to palpationStop using prosthesisMoisturizerCorrect underlying problems: Curb weight gain (diet/exercise) Treat edemaFigure 5FolliculitisItching, possibly pain, pimpleŽ (properly termed Direct visualization of folliculocentric Typically with erythemaDecrease heat and friction (remove prosthesis if possible)Topical or systemic antibioticsAvoid shaving area (increases incidence)Figure 6AbscessInammation with erythema and severe painVisualization of erythematous nodule that is exquisitely painful Incision and drainage absolutely necessary by physician, may also need systemic antibioticsKeep area cleanAvoid shaving aected areaFigure 7XerosisDry skin, may have erythema and/or itchingDry scaly or aky skin, may have excoria-tions or erythema Moisturizers (over-the-counter)Keep area clean Maintain hydration (systemi- prosthetic users to see a physician when they have failed conservative therapy or have a lesion that wont heal. It is imperative that these lesions are evalu-Avoiding skin complications begins with Clean all parts of your prosthesis daily that contact your skin. The reverse is also skin daily that contact your prosthesis. Dont rely on feeling a problem as your primary means of detecting skin prob-lems. Many patients are desensitized and cant feel damage to the skin. The best inspections make use of a mirror or a limb. Every amputees needs are unique, your provider. If you encounter a skin problem that you are unable to resolve or that will not heal, then the “rst step is to see your prosthe-tist. The prosthetist can then determine if the problem can be resolved pros-thetically or through other conservative means. If not, the prosthetist may refer you to your primary care physician or a Skin issues are very common among amputees. Because amputees require an unusually high demand from their skin, and because not wearing a prostheses need to be taken seriously. A simple skinbreakdown can lead to more severe prob-lems, such as infection, cancer, osteo-revision surgery. Start with your prosthe-tist to determine, and hopefully resolve, the problem. If your prosthetist cannot Photos provided by James Highsmith, Jason * Polysporin® is recommended over Neosporin® due to a high incidence of allergic contact dermatitis. Consult your dermatologist for more information. Contact the Amputee Coalition at 888/267-5669 or amputee-coalition.org 43 PARTICIPANTS NEEDED ELECTRICAL NERVE POST-AMPUTATION PAINWe are looking for volunteers tion for patients suffering from chronic post-amputation pain. Your participation would involve 7 ofce visit sessions, each of which is approximately questionnaires. In appreciation for your time, you will receive $50 per ofce visit for a total reimbursement There will be no cost to you for taking part in this research study. The clinic visits, tests and surgical procedures that are done as part of the research study will be free. For more information about this study, or to volunteer for this study, please contact:Dr. Amol Soin8934 Kingsridge Dr. www.ohiopainclinic.comThis study has been reviewed by, and received ethics clearance through, the Copernicus Group Institutional Review Board Figure 4. Negative pressure hyperemia in an above-knee limb Figure 5. Folliculitis Figure 6. Infected abscess on a below-knee residual limb Figure 7. Xerosis Contact the Amputee Coalition at 888/267-5669 or amputee-coalition.org 43 Figure 4. Negative pressure hyperemia in an above-knee limb Figure 5. Folliculitis Figure 6. Infected abscess on a below-knee residual limb Figure 7. Xerosis