Skin grafts and scars on TT
Randall McFarland, CPO
Description
Collection
Title:
Skin grafts and scars on TT
Creator:
Randall McFarland, CPO
Text:
Hello List members-
I have a mid 30's female client who sustained a traumatic vehicular
accident resulting in a 6 inch TT amputation. Virtually the entire remaining
part of the skin below the patella on her amputated leg is split thickness
skin graft and scars- some of which are open and still a ways from healing.
Because of her relative youth, I don't blame the doctors for trying to save
her knee... she will still have the option of going TK in the future if
weight bearing is not tolerated by the skin.
My questions for discussion are:
1) What has been your experience in fitting such extensive scarring and skin
grafts? Is the physician able to take any steps during healing to minimize
the formation of adherent scars or so we just have to deal with them after
all healing is completed?
(With normal skin, we try to mobilize the skin, but I fear that grafted skin
is less tolerant of such manipulation.)
2) My initial thought is that a viscoelastic liner would be the way to
supplement the dermal layer loss, but does this liner's ability to absorb
shear forces compensate for it's propensity to adhere to the skin? (For the
liner to actually absorb shear, the skin would have to participate) Would a
thick, soft, cushy, dry sock actually be friendlier to such skin by actually
allowing some slide at this interface?
3) Obviously, an optimum combination of good suspension, lightweight
components and a VSP would help minimize shear forces, but I'd like to hear
what has or hasn't worked for you in your most challenging cases.
I will post the responses for the benefit of the list members. (If for any
reason you don't want your name included, put it in parentheses.)
Consider this...the better we all can do for our clients, the better our
profession will be recognized as a whole. In turn, this will eventually have
it's rewards for all which will attract more good people to the field!
Thanks for your concise input!!
Randy McFarland, CPO
Fullerton, CA
I have a mid 30's female client who sustained a traumatic vehicular
accident resulting in a 6 inch TT amputation. Virtually the entire remaining
part of the skin below the patella on her amputated leg is split thickness
skin graft and scars- some of which are open and still a ways from healing.
Because of her relative youth, I don't blame the doctors for trying to save
her knee... she will still have the option of going TK in the future if
weight bearing is not tolerated by the skin.
My questions for discussion are:
1) What has been your experience in fitting such extensive scarring and skin
grafts? Is the physician able to take any steps during healing to minimize
the formation of adherent scars or so we just have to deal with them after
all healing is completed?
(With normal skin, we try to mobilize the skin, but I fear that grafted skin
is less tolerant of such manipulation.)
2) My initial thought is that a viscoelastic liner would be the way to
supplement the dermal layer loss, but does this liner's ability to absorb
shear forces compensate for it's propensity to adhere to the skin? (For the
liner to actually absorb shear, the skin would have to participate) Would a
thick, soft, cushy, dry sock actually be friendlier to such skin by actually
allowing some slide at this interface?
3) Obviously, an optimum combination of good suspension, lightweight
components and a VSP would help minimize shear forces, but I'd like to hear
what has or hasn't worked for you in your most challenging cases.
I will post the responses for the benefit of the list members. (If for any
reason you don't want your name included, put it in parentheses.)
Consider this...the better we all can do for our clients, the better our
profession will be recognized as a whole. In turn, this will eventually have
it's rewards for all which will attract more good people to the field!
Thanks for your concise input!!
Randy McFarland, CPO
Fullerton, CA
Citation
Randall McFarland, CPO, “Skin grafts and scars on TT,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 8, 2024, https://library.drfop.org/items/show/216999.
