Results Re: BKA recurring cyst
Marty Mandelbaum
Description
Collection
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
.
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 25, 2024, https://library.drfop.org/items/show/219512.
