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

Abstract

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.

Residual Limb Health and Prosthetics

“…A recent study was the first to directly test the effect of EVS on residual-limb skin health and blood flow [20]. This study used a standardized non-invasive imaging (Figures 4-7) approach with a combination of out-of-socket imaging (e.g., hyperspectral imaging, transepidermal water loss (TEWL) and surface electrical capacitance (SEC)) and in-socket imaging (e.g., transcutaneous oximetry (TCOM), laser Doppler flowmetry (LDF)) [20,33]. Outcomes of this study identified that elevated vacuum suspension socket systems promote better residual limb skin physiology by preserving the skin barrier function (TEWL measurements), rescuing against loss of tissue oxygenation during activity and attenuating reactive hyperemia.…”

“…Data are mean perfusion units ± SE (shown as error bar). *p<0.05 O vs I within gp at time point (reprinted with permission from Rink CL et al[33]).…”

“…*p < 0.05 SoC vs. EVS within time point. †p<0.05 baseline vs. final within prosthesis group (reprinted with permission from Rink et al[33]).…”

“…Oxygen permeable Tegaderm TM was used to adhere the TCOM probe to the limb. (C) The silicone gel insert enabled reproducible placement and spacing of probes and buffered against the liner from pressing probes tightly against skin (reprinted with permission from Rink et al[33]).…”

Resting TcPO2 levels decrease during liner wear in persons with a transtibial amputation

“…Residual limb TcPO2 in persons with a lower limb amputation is considerably reduced. Rink et al compared resting TcPO2 levels in five persons with a transtibial amptuation (four due to trauma, one due to infection) while wearing and not wearing a liner [26]. It is unknown whether the participants had any undelying conditions such as PAD or were suffering from RLP.…”