Title: Skin Problems in an Amputee Clinic
Authors: Dudek NL, MD, Marks MB, MD, Marshall MC, MD
Source: American Journal of Physical Medicine & Rehabilitation; 85(5) 424-429.
PODIATRIC RELEVANCE:
As podiatrists, we are experts in limb salvage of the lower extremities. However, there are instances when it becomes necessary to amputate a portion of the limb, after which the patient must ambulate with some sort of prosthetic device. Patients must adjust to life with the prosthetic, and to the possibility of new dermatologic pathologies that might arise secondary to their prostheses.
METHODS:
This article entails a retrospective chart review from July 1997 to June 2003 at the Rehabilitation Centre in Ottawa, Canada, using the physician notes and discharge summaries for patients with lower extremity prosthesis secondary to amputation. Only patients who use their prosthesis for transfers or walking were included in this study. The data collected included patient demographics, amputation details, and skin lesion details. Each skin lesion was considered a different case in this study.
RESULTS:
The study looked at 528 different skin lesions on 337 limbs. Of these lesions 70.3% of them were distal tibial lesions. Nineteen different skin conditions were diagnosed. Ulceration (26.7%) was the most commonly diagnosed lesion. The five most common lesions were ulceration, irritation, inclusion cyst, callus, and verrucous hyperplasia and accounted for 79.5% of the cases. PVD/diabetes was the most common cause of amputation for patients who experienced ulceration, irritation, and verrucous hyperplasia. On the other hand, traumatic amputation was the most common amputation for inclusion cyst and callus. The fit of the prosthesis was the most common cause of skin lesion (79.5%-95.0%).
COMMENTS:
It is important to remember as podiatrists, amputation of the foot does not terminate our relationship with the patient or our care for them. Numerous dermatologic issues, not just ulcerations, may arise from prosthetic usage that requires further treatment and prosthesis adjustment.
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Disclaimer:
Scientific Abstract Monthly postings are submitted by podiatric surgical residents. The ideas presented are not the opinions of the American College of Foot and Ankle Surgeons (ACFAS), nor are they presented as facts. ACFAS presents this information without any warranty of any kind, expressed or implied, and is not liable for its accuracy nor for any loss or damage caused by the user's reliance on information obtained in these areas.