Results Re: BKA recurring cyst

Marty Mandelbaum

Description

Title:

Results Re: BKA recurring cyst

Creator:

Marty Mandelbaum

Date:

8/12/2002

Text:

Original Message -----

From: Marty Mandelbaum < <Email Address Redacted> >

To: < <Email Address Redacted> >

Sent: Friday, August 09, 2002 7:08 PM

Subject: [OANDP-L] BKA recurring cyst

 This is posted for a colleague:

 I have a very active bka, who wears a dermo liner, and gets cysts that

> can drain enormous amounts of fluid from time to time.

> He has been to the MD. and feels exploratory surgery would be the next


> step. The patient is self employed and can't miss work.

> Adjustments to raise the wall in the popliteal to try and contain the

> cyst, did not work the wall then lowered below the cyst. This seemed

> to work for a while. >

> Recently the patient came to office because he completely trashed his

> OWW Pathfinder, they sent a loaner and within a day the cyst came

> back. The alignment and pressure were the same as the broken foot had
been.

> The patient is questioning if anyone else has similar situations and

> possible solutions other then surgery?

Responses:

1- Whenever I have had problems with recurrent cyst formations I have
found my

socket contours to be incorrect. I find the only solution is to issue
room in

the cyst formation region and place pressure adjacent. I also look for
signs

of pistoning, liner wear, other suspension related maladies. Joe Perry
CP

2- Just a thought, have the patient change their dermo liner several
times a

day. This would be an experienced guess as there was no indication as to

the location of the cysts.

3- Over the years I've had two cases exactly as you've have described.
The

cases were about ten years apart. Both men ended up having surgery. The

cysts never came back and it sure made my life easier. I think I must
have

tried 20 styles if posterior brim designs. None of them worked.

John MacGregor, C.P.

4- On the occasions that I have seen these cysts they occur on patients
with fair skin in the fossa area and come and go with regularity.You can
lower the wall or create a pocket for the cyst to live in. Surgical
removal and possibly a skin graft over the area end the problem
altogether. G. Yackley CP

5- Yes, I have had a few clients with this same problem. Most instances
it was

around the popliteal region. Changeing the socket design from standard
PTB

with reductions for 3s systems, to a hydrostatic design. Casting under a


pressureized system will reduce the need for modification in the
popliteal

region. Other cases a thin half ply sock or sheathe has been worn under
the

liner. Each case has responded diffrent. One client developes small
cysts in

random areas. Currently wearing an iceross sport. His remedy is to
lightly

dust residual with Goldbond powder, and swears by it.

Jay Manaughten BOCOP

6- Physicians at our hospital would not advocate surgery for a cyst, but
modification of the prosthesis. Al


7- I had similar problems with a bka as well and I realized the problem
was that

the patient had gained weight and the socket was too tight causing too
much

pressure along the posterior brim. When we did a socket replacement the
cyst

problems resolved themselves. Something to consider. Mark T. Maguire,
CPO

8- I am R-BK from 1969 motorcycle accident. I wear a PTB, hard socket,
3x

stump sock, Smith suspension. Simple. But I also used to have recurring
soft

tissue abscesses posterior popliteal. They would appear maybe as often
as

monthly, and would occasionally require a physician to I&D them, tho
more

often than not were treated with antibiotics, hot soaks, and some weight


bearing which would open and drain the abscess. No physician required
except

for an Rx for antibiotics (Keflex 500mg QID)

To this day I have no idea what caused them, nor do I know what made
them

go away. Maybe it was the new prosthesis, but they have not been a
problem

for years. Oh sure, now and then I will get an infection, but it does
not amount

to much. It appears, I gobble antibiotics, soak, do some weight bearing,
it

opens up, drains, and it's gone again for months.

Wish I had some magic fix for your client, but alas I do not. I am
curious

about one comment:

MM> He has been to the MD. and feels exploratory surgery would be the

MM> next step. The patient is self employed and can't miss work.

Certainly a last resort. But, one surgeon suggested the reason they
recurred

was due to the presence of necrotic tissue....and like a pilonidal cyst,
excision

of a large mass of tissue is the fix, assuming they get it all. WIth a
pilionidal, a

huge mass is removed and the wound is left open to granulate...heal from


bottom up. It hoits like hell.

But where are his priorities? Does his self-employment require the use
of his

brains or is it dependent on his leg? If his leg, I suppose it might
cost him a

few bucks, but the recurring infection also costs him money, no? Hard to
use

your residual when it is sore from an abscess.

If he uses his noggin rather than his leg to earn a living, the
temporary or

short-term loss of weight-bearing might compensate for long-term gain to
be

derived...to be rid of the abscess. Good luck Wayne Renardson, Nashville
TN

9- Surgery is the only way to get rid of them. Make sure the surgeon
takes the WHOLE core out which can be deep. The only other temporary fix
I know of is to have him put a washcloth soaked in hot water on the
cyst. This will make it burst and drain but wont solve the problem long
term. P

10- There was a recent post regarding this and several replies. Mine
was one of

them. AFter numerous rounds of antibiotics and attempts at prosthetic

accommodation, my patient required surgical intervention to remove scar

tissue which was causing the recurring cyst. After the surgery it never

came back. David Yates, CPO, FAAOP


11- Marty please post results I have the same thing going on and I'm a
bk as well. Robert Carlile, RTPO, Texas Scottish Rite Hosp, 214-559-7440
.

                          

Citation

Marty Mandelbaum, “Results Re: BKA recurring cyst,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/219512.