Skin Rash responses

Skin Rash responses

Bradley, Kristin

2/17/2003

Here is the summary of responses. My original post is at the end of the
summary. As a new-er practitioner it is comforting to know that most of your
responses matched what I had been hypothesizing... we'll keeping working
until we get it right!! Many thanks to all who responded. Happy President's
Day to my US friends.
=Kristin
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If it is a friction rub you may want to try some type of friction reducer,
give Vaseline a try. You may also want to try a sheath. Another possibly
would be to increase the radii of the socket and make sure no loose tissue
is hanging over the socket rubbing on a thin ridge. The problem does sound
more like a rub of some kind rather than a reaction to the socket material.
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My first guess would be heat rash from perspiration. With increased activity
and function, maybe she's perspiring more. I would try a clear gel or roll
on antiperspirant around and slightly above the problem area about 5
minutes before donning the prosthesis. Good luck. Karl Barner, CPO
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That's an interesting problem you have there.
Does she have tissue that folds over the proximal brim anteriorly? Does the
rash go all the way around? Is the sock longer than the socket? Have you
tried changing the material of the sock? Or maybe lining the brim with
leather? Just a few thoughts but I'd love to know what you end up figuring
out.
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As to the skin rash, my gut instinct is that it could be a couple of things.
With it being only on the border, it sounds like one of two issues: changing
environment or skin friction. When looking at it, is the skin rough or is it
like pimples. If rough, then friction, if pimples then environment. For
friction, I would first try a longer one ply sock and have it roll over the
socket and down. Also, a prosthetic sheath would greatly help. For
environment, the closest analogy is the border on a silicoln liner to skin
at the proximal edge. With this one, one goes from an anaerobic to aerobic
environment, and thus there is an area of conflicting resident microbes and
changing environment which produces a reaction in the dermal layer. For
this, I have used a short nylon at the edge approx two inches long in order
to make a stable uniform environment. Not seeing how the leg fits and the
area, I would suggest that you try to find some sort of medium that allows
air to penetrate and not cause issues around the area where the changing
environment occurs. Cut vaccuum tube is cheap and readily available so I use
this on BK's.
Hope this helps and is my two cents worth.
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I guess it would matter what the rash looks like. Is it a pressure type
rash, caffing, foliculitis? Maybe she hasn't had pressure on this area in a
long while and it has to toughen up.
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Lubrication, vaseline or amp-u-balm can eliminate the possibility that it
is friction of traction. Is the rash inside the socket or at the outside
brim? (edge pressure)
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Possibly you are looking at a skin traction problem. Try using a nylon
sheath against the skin.
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Try more flexible socket materials like Otto Bock Thermolyn soft or proflex
from
Guard industries. Have her put some A&D ointiment on the area before
donning.
That, along with more flexible materials should help.
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Original post:
>Hi All,
> Please help if you can. I have done approximately 15-20 AK sockets in my
>short career. I am currently in the test socket stage of fitting a long
time
>prosthetic user with a new limb. It is a simple quad socket, one ply fit,
>silisian belt suspension. She absolutely loves it and feels very
comfortable
>when walking. The alignment looks excellent and her gait is much improved
>with a new socket and newer components. Her previous socket was too small
>(due to weight gain) and she had been walking about 1.5-2 off the seat of
>the socket, had a moderate adductor roll and apparently poor gait pattern
>(circumduction in swing and outset foot placement in stance).
> My problem (and, of course, her problem) is an awful skin rash that
occurs
>along the proximal brim, when she wears the test socket. At first it took
>about two days to appear and now recurs within an hour of wear. I thought,
>at first, that perhaps the proximal dimensions were too tight, so I opened
>it up a bit. No change. Then I thought we should change the material. We
>tried going from Surlyn to PetG/ Vivak. Next I think I should laminate but
I
>doubt this will help. This is where I need assistance!! Am unsure if this
is
>an allergy, pressure, traction, friction rub, etc.
> Please tell me what you think. Thanks in advance.
>
>Sincerely,
> Kristin Bradley, CP, CP(c)


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