Diabetic BK's

Diabetic BK's

aryeh

11/19/1999

Dear list members;

I'm a CPO seeing a lot of the following situation, and given the
restrictions under which I must work, I'm open to suggestions.

Presented with:
BK amputation, first time fittings in a rehab setting. Well-healed,
non-edematous limbs, usually diabetic, some bilateral cases. Usually
properly using elastic bandages for shaping and edema control, with
varying consistency, though the wrapping doesn't seem to be a factor. I
usually see them a minimum of several weeks post-surgery.

The general protocol(over which I have very limited control):
PTB-PTS total contact endoskeletal, pe-lite liner with soft distal
end-cap, simple components (e.g.,Otto Bock steel, SACH foot). Usually a
knee sleeve for extra suspension aid. Modifications are
by-the-book-normal; relief along tibial crest, fibular head, etc. A lot
of PT weight bearing is the norm here. Corsets or strap suspension are
about the limits of variety here.

Specific problem:
A large percentage, not sure how large, are experiencing a hematoma,
usually on the anterior, proximal aspect of the tibia. It presents as a
roughly triangular, blotchy discoloration, darker red than that which
results from pressure, does not blanch from finger pressure. Sometimes
accompanied by swelling in that area, sometimes painful. It will become
light black-and-blue if the prosthesis is used in that state.

I think this is a result of blood and fluid pooling in the areas of void,
pressed into the area by surrounding areas of total contact.

Sometimes a Silipos sock helps (we usually try this first, we use them
frequently, anyway). Sometimes a soft pad inside the liner helps.
Occasionally a corset is used to remove weight bearing. This usually
works as a last resort, but has its accompanying inconveniences.

Restrictions (they are not in my control):
Exotic liners, e.g., Iceross, TEC, multi-durometer with leather liners
are NOT an option. PT weight bearing for non-corset wearers ARE required.

I've considered a multi-durometer liner without plaster build-ups on my
models except distal anterior (where this problem has not occurred), and
without a leather lining, but have to figure out a simple way to make
them-if it makes sense to do it at all.

I have very limited leeway for experimentation, but could probably swing
a little through if it doesn't require much in the way of material
resources.

Thanks in advance,
Aryeh