Responses to Surgical Silicone Implants inquiry

Responses to Surgical Silicone Implants inquiry

Custom Prosthetic Services Ltd

8/1/2003

Original Post:

A client of mine who suffers from Reflex Sympathetic Dystrophy, recurrent in her trans tibial residual limb, has asked me if there is any history of people receiving surgical silicone implants in the form of distal tibial / fibular padding. I am not familiar with such a technique, if it has ever been done, and I am interested to know if the Listserve members have any related knowledge or experience?

Thank you,
Geoffrey Hall, C.P. ( c )

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Rsponses:


    I have worked with a few RSD cases, and without knowing more detail, I
offer a suggestion - to consider creating the most physiologic, biologic
residual-limb first. Providing the body with as natural functioning
residual-limb as possible would be my first recommendation. This would be in
the form of the Ertl Reconstructive Amputation Surgery. There is sufficient
evidence that indicates this surgical reconstruction provides an amputee
with the most natural physiologically functioning limb. This would provide
greater possibility in reducing any further metabolic drain.
    If there is sufficient muscle and soft-tissue to perform this
reconstruction, I believe the silicone implant is more of an attempt to
ameliorate a symptom. The risk/reward of the silicone implant is to be
strongly considered. There was a Dr. Swanson in Grand Rapids Michigan who
performed a few silicone implants. I saw two of those patients, one above
the knee. This man was complaining of pain at the terminal femur and all
medical and rehab people could not resolve his problem. I saw him, palpated
what appeared to be a very prominent hypertrophic distal femur, and a
segment was slightly mobil. I ordered x-ray and found what I later learned
was a silicone implant that initially was inserted in the bone marrow - an
upside-down mushroom shape. It had slipped out of the marrow and turned
sideways. All the medical and rehab, prosthetists somehow missed this. I
believe Dr. Swanson also implanted silicone bags, similar to the breast
implants of today.

Jan Stokosa, C.P.
Michigan



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Silicone plugs have been used for overgrowth, but I have never seen reports for
RSD.


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Check out the Ertl procedure. See OANDP-L archives at:
<URL Redacted>

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Dr. Swanson, of the swanson metacarpal-phalangeal implant, attempted to seal the end of the tibia with a silicone implant in the 1970's. Did not work as they had hoped.

I would echo Jan Stokosa's comments regarding reconstruction. There really isn't any published material regarding the correct path to take with and RSD patient, except that many feel that surgery should be avoided. We, my cousin and I, have a few patients who have RSD and who have undergone reconstruction. The RSD has improved. Again, not published and scientific evidence, ie. protein marker, cytokine, etc, to show how this improved. But, improving the physiology and biology of a residual limb may help.


William J. Ertl (HSC)

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I do recall reading a newspaper story about an RN who had patented a design
for a mushroom shaped silicone pad to be positioned over the end of the
tibia during an amputation. Do not know if it was ever used.

I honestly doubt that such an intervention would be helpful for RSD......


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During the 1970's Dow Corning made some mushroom shaped distal bone plugs that were implanted during surgery. I believe that it was written up in the predecessor to Journal of Orthotics and Prosthetics (JPO). I don't remember the center that was involved, but I don't believe it went very far.


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