Skin that comes in contact with the prosthesis must be cared for meticulously to prevent skin damage such as irritation, skin breakdown, and infection. Skin breakdown is the process of skin being worn away, possibly resulting in sores.
Usually, the disorders that put people at risk of amputation (such as blood vessel disorders or diabetes, which decrease circulation to the limbs) also increase the risk of skin breakdown and infection after amputation. Some of these disorders (such as diabetes) and others (such as neurologic disorders) impair the ability to feel pain and other sensations. People with such disorders may not feel discomfort or pain when skin breaks down or infection develops and thus do not notice these problems. These people should remove their prosthesis several times a day to check the skin for redness and other signs of breakdown or infection. Other people should check for these signs at least once daily.
Skin problems can be serious and should be evaluated and treated as necessary by a health care practitioner in consultation with a prosthetist. As people become familiar with recurrent problems, they may be able to identify which problems are minor and manage them on their own. However, anything unusual, persistent, painful, or worrisome should be evaluated by a health care practitioner.
Preventing Skin Breakdown:
The skin next to the prosthesis tends to break down because the prosthesis puts pressure on and rubs against it and because moisture collects in the space between the stump and prosthetic socket. The first sign of skin breakdown is redness, which may be followed by cuts, blisters, and sores. When skin breaks down, the prosthesis is often painful or impossible to wear for long periods of time, and infection can develop. Infection can lead to serious problems, including the need for a second operation (called revision surgery).
Several measures can help prevent or delay skin breakdown:
When people see signs of skin breakdown, they should promptly see a health care practitioner to be evaluated and a prosthetist to have the prosthesis adjusted. People should avoid wearing the prosthesis when possible until it can be adjusted.
The socket of the prosthesis creates an airtight, warm, damp, contained space where the person's natural body oils and sweat collect—an environment that encourages the growth of bacteria and development of infection. Damp skin tends to break down, giving bacteria easy entry into the body. As a result, infections may spread.
Signs of infection include reddened skin, sores, a discharge of pus, tender spots, and rashes. A bad odor may indicate infection or poor hygiene. Bacterial infections may begin as a pimple or painful red area. However, they can form a pocket of pus (an abscess, similar to a boil) or lead to a spreading infection (such as cellulitis) or to impetigo (an itchy, scabby rash). Bacterial infections may cause fever and a general feeling of illness (malaise).
Any sign of infection should be evaluated promptly by a health care practitioner. The following symptoms require immediate evaluation to prevent infection from becoming life threatening:
If people who wear a prosthesis think that they have a bacterial infection, they should see a health care practitioner immediately. Treatment often requires drugs, applied topically or taken by mouth.
To help prevent infections, people who wear a prosthesis should wash the stump with antibacterial soap at least once a day. The soap should be unscented and uncolored. People who sweat a lot or who are prone to rashes or infections should wash more frequently. An antiperspirant spray can be used, but it should have no scent or other additives. Sprays with less than 15% aluminum chloride can be obtained over the counter. Stronger antiperspirant sprays can be obtained with a prescription. Alcohol-based lotions should not be used because they dry the skin, increasing the risk of skin breakdown. Baby oil is best for maintaining lubricated, soft skin.
Any part of the interface that touches the skin—the socket, prosthetic sock, or liner—should also be washed thoroughly every day with hot water and antibacterial soap.
Liners and prosthetic socks should also be dried thoroughly before putting them on. Soap left in the socket or liner can cause rashes, so people should make sure that the socket and liners are completely free of soap after washing. An itchy rash usually indicates irritation or an allergic reaction, not infection. A doctor can prescribe a cream or ointment to treat rashes.
Fungal infections (see see Fungal Infections) should be treated with an over-the-counter antifungal cream. If the diagnosis of a fungal infection is not clear or if fungal infections persist, a doctor should be consulted.
Preventing Other Skin Problems:
Ingrown hairs and infection of the hair follicle (folliculitis), although not dangerous, can cause substantial pain and discomfort. Drawing salves, such as ichthammol, can help. Drawing salves draw out infection and other objects, including ingrown hairs, from the skin. Not shaving the hair on the stump can help prevent these problems.
The appearance of rough, warty bumps, usually at the far end of the stump, can result from an ill-fitting interface. If untreated, this disorder, called verrucous hyperplasia, can lead to a serious infection. If bumps resembling warts appear, people should immediately consult the prosthetist to check the fit and adjust the interface as needed. Then they should see their doctor so that verrucous hyperplasia can be treated.
Last full review/revision May 2007 by Erik Schaffer, CP