A large percentage, up to 46% in some cases, of amputees experience prosthesis discomfort due to skin irritation. Considering that each amputation is unique with one-of-a-kind fit needs, it’s understandable that getting a perfect fit isn’t easy. However, prostheses are a doorway to mobility and a full, active life, and skin health plays a pivotal role in the prostheses’ success.
The term “skin care” conjures up images of heavily-scented oils and creams to prevent wrinkles, but for amputees, skin care is as necessary as brushing teeth. It maintains the skin’s integrity and strength for the successful use of the prosthesis.
The Forces at Work on the Skin
Amputation causes the bones, muscles, and surrounding tissues to undergo forces they weren’t designed to withstand. The mechanics of movement doesn’t follow the natural pattern, and there are thermal issues too. Heat and the resulting sweat of the residual within the prosthesis creates a problematic environment for the skin.
Prostheses abandonment happens for a variety of reasons, and the rates vary between upper and lower limbs. However, 22 percent of those with lower-limb amputations (LLP) abandon their prostheses within the first year. Years later, up to 37 percent will only use them indoors. Upper limb prosthesis abandonment rates fall between 20 to 30 percent.
Cause of Prostheses Discomfort and Abandonment
- Skin Irritation: The skin is the body’s first defense against infection. While it’s tough, the forces applied by a prosthesis put stress and pressure on areas never designed to take the full weight of the body or the forces needed to move a limb. Chafing and blisters can lead to more serious infections. Once you start using the prosthesis less, it can lead to lower activity levels and muscle loss that alters the prosthesis’ fit, causing further irritation.
- Body Pain: The body naturally compensates for loss, making back and shoulder pain common among amputees. Prostheses create imbalances that require training, practice, and frequent adjustments. Abandonment results when pain and problems outweigh the benefits of wearing the prosthesis.
- Residual Limb Pain: Every amputation is different. Some present more difficult fit challenges than others. Lower limb amputations face greater forces, while those with upper limb amputations face dexterity and movement issues that contribute to prosthetic abandonment.
Preventative Skin Care
Vigilance and commitment to healthy skin promote and contribute to continued mobility. It’s a multi-stage process that can easily become part of your daily routine.
1. Daily Skin Checks
Before donning and after taking off your prosthesis, give your residual a good once-over. Use a mirror to check areas that you can’t see.
You’re looking for:
- Red spots that don’t disappear after five to ten minutes
- Any swelling, especially swelling that alters the fit of your prosthetic
- Hot spots, burning, or painful areas
- Blisters
- Ulcers
- Cold spots (poor circulation)
- Tender areas
- Odor changes
- Discharge
- Swelling lymph nodes
Most of these issues indicate a fit problem, which requires a visit to your prosthetist. Prosthesis discomfort isn’t something to tough out. Redness or swelling might seem small, but stopping problems before they progress prevents limits in mobility and eventual prosthetic abandonment.
If you’ve been particularly active or sweaty, check your residual’s skin throughout the day. You might need to add, change, or dry out your sock or socket to maintain a healthy skin environment.
2. Keep It Clean
The heavy stress, heat, and humidity within the prosthetic’s socket can cause cracks in the skin where bacteria can enter. Cleanse your residual every morning with a gentle cleanser with moisturizers that keeps the skin moist, flexible, and strong. You may need to shower or clean your residual more than once a day to keep it clean, especially if you’re sweating. However, cleanliness maintains your mobility.
3. Dry
After cleansing, completely dry your residual. If you know you’ll be sweaty during the day, apply a liquid-to-powder product that creates a protective barrier between the skin and the sock/liner. This barrier reduces the rubbing and chafing that leads to general skin irritation.
4. Moisturize
Dry skin cracks, creating an opening for potential infection. After washing and drying, moisturize the skin to maintain its integrity. If you cleanse the skin again throughout the day, dry and moisturize it again to keep it strong and flexible. Give the moisturizer time to dry, then don your prosthesis. Your skin heals while you sleep, so moisturize before bed too.
5. Check and Recheck
This is number one, but it’s the last on the checklist too. Check and recheck the residual’s skin. Muscle loss, muscle gain, and changes in the weather that affect swelling are all reasons your prosthesis’ fit may start to irritate the skin.
If you notice fit problems with your prosthesis or experience skin irritation that you cannot clear up on your own, contact your prosthetist or dermatologist. Early intervention can make sure you maintain mobility.
