Skin problems in individuals with lower-limb loss: Literature review and proposed classification system

Bui, Kelly M.; Raugi, Gregory J.; Nguyen, Viet Q.; Reiber, Gayle E.

doi:10.1682/jrrd.2009.04.0052

Cited by 26 publications

(25 citation statements)

References 40 publications

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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: 89%

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

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162

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: 89%

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

Self Cite

162

167

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show abstract

“…Specifically, the patient complained of pain and stiffness in his sound side knee joint that were likely due to the gait asymmetry, and his limb displayed contact dermatitis, a condition that can be caused by factors involved in the residual limb and socket interface such as weight distribution and shear force. 9 The negative effects of the prosthesis resulted in its occasional disuse. The patient expressed a lack of confidence in daily activities such as getting down from a tractor, climbing a ladder, and walking on uneven ground.…”

Section: Case Presentationmentioning

confidence: 99%

Using Elevated Vacuum to Improve Functional Outcomes: A Case Report

Sutton

Hoskins

Fosnight

2011

JPO Journal of Prosthetics and Orthotics

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Elevated vacuum (EV) is a promising technology in the field of prosthetics. It has been shown to improve the fit of the limb in the socket, resulting in many possible benefits to the function of a prosthesis. However, very little research has been done on its effect on patient function. This unique case report documents the effect on one patient's function of transitioning from a patella-tendon-bearing (PTB) socket with ischial weightbearing thigh cuff (IWBTC) to a prosthesis with an EV socket system. The patient underwent a transtibial amputation as a result of an avulsive trauma and used the PTB socket and thigh cuff for 16 years. In an effort to correct the patient's gait and improve his ability to perform the necessary tasks of his occupation, farming, the patient began using an EV prosthesis. He was interviewed and his functional status was evaluated 1 week, 1 month, and 1 year after receiving the prosthesis. After 1 week, the patient showed improvement in skin condition and expressed increased confidence in difficult locomotor tasks. At 1 month, he was no longer experiencing pain in his sound side knee and his gait symmetry had improved dramatically. After 1 year, the patient showed further improvement in gait and balance as well as the ability to wear the prosthesis comfortably for 24 hours at a time when necessary for his occupation. The transition from a PTB with IWBTC prosthesis to an EV system dramatically improved this patient's functional outcome and lessened the negative effects associated with wearing a prosthesis. (J Prosthet Orthot. 2011;23:184 -189.) KEY INDEXING TERMS: lower limb, prosthetics, function, outcomes, vacuum, subatmospheric I t is the goal of all prosthetic interventions to maximize patient function. Research has shown that physical mobility is the only independent factor that significantly affects quality of life in amputees when compared with nondisabled persons. 1 Although they theoretically have the highest probability of achieving normal functioning, 2 patients who have undergone amputation due to an avulsive trauma generally have secondary injuries that complicate their recoveries. For transtibial amputees, injuries typically include extensive damage to the patellar tendons and hamstring group. It is possible to accommodate for the resulting gait deficiencies with a patellatendon-bearing (PTB) socket connected to an ischial weightbearing thigh cuff (IWBTC) with external knee joints and check strap (Figure 1). In this type of prosthesis, the external knee joints and check strap combine to prevent knee hyperextension in the PTB socket, accommodating the hamstring group weakness. The forces responsible for hyperextension on the residuum are countered by the check strap. 3Alternatively, there is an emerging technology that shows promise as a replacement for traditional prosthesis designs: elevated vacuum (EV). Also known as subatmospheric, EV prostheses consist of an elastomeric liner, total surface bearing socket, mechanical or electronic vacuum pump, and a sealing sleeve. Des...

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“…In addition, because of the challenges with socket interfaces, people with prosthetic limbs are likely to develop frequent skin complications, including irritation, breakdown, ulceration, cysts, and necrosis [15].…”

mentioning

confidence: 99%

Ethics in Rehabilitation: Access to Prosthetics and Quality Care Following Amputation

Pasquina

Carvalho

Sheehan

2015

AMA Journal of Ethics

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Skin problems in individuals with lower-limb loss: Literature review and proposed classification system

Cited by 26 publications

References 40 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

Using Elevated Vacuum to Improve Functional Outcomes: A Case Report

Ethics in Rehabilitation: Access to Prosthetics and Quality Care Following Amputation

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