Difficult Case
Steve Scott
Description
Collection
Title:
Difficult Case
Creator:
Steve Scott
Date:
11/7/2011
Text:
Hello All,
I'm looking for ideas on and interesting patient that I'm working with.
This is a 45 year old gentleman with a Tranfemoral amputation about 8.5
CM from the I.T. in length. While this is relatively straightforward,
he also has Epidermolysis Bullosa which leaves him with very thin skin
that cannot tolerate shear forces and is susceptible to infection.
Indeed, it was infection that led to the loss of the limb. He also has
substantial scarring in the inguinal region due to an investigation for
cancer of the lymph glands. Further complicating the situation is the
fact that he is also essentially a bilateral partial hand amputee as all
the fingers have been fused and partially amputated, and the skin is
very fragile to the point where he experiences skin breakdown just using
the parallel bars. This reduces his ability to pull anything on strap
anything up and even impairs his ability to don the prosthesis and needs
help doing so.
Presently he's wearing a full suction socket with flexible inner liner
and a TES style waist belt, incorporating a Total knee and Trias foot.
Stability is his main issue but weight is also an issue and I've
attempted to make things a light as possible to reduce the shear forces
on his skin. I've be successful in getting him to walk without skin
breakdown, however, he does feel that the socket comes loose or makes
noise at the time one would typically expect ( standing from sitting,
etc.). I would like to improve the suspension, He's asked about pin
liners etc, my concerns are that with such a short residuum a pin liner
would put too much shear force onto the tissues and that we'd have even
more issues trying to get the liner on consistently. Plus the material
of the liner would be a concern as accumulation of bacteria would
increase the potential for infection which he is already at higher risk
for.
If anyone has any experience with situations such as this I would
greatly appreciate any input that would help me to come up with
something that will allow this individual to achieve maximum possible
mobility. Please don't hesitate to contact me if you need any further
information.
Thank you in advance.
Steve Scott, CP(c)
Cascade Prosthetic Services.
403-283-2979.
I'm looking for ideas on and interesting patient that I'm working with.
This is a 45 year old gentleman with a Tranfemoral amputation about 8.5
CM from the I.T. in length. While this is relatively straightforward,
he also has Epidermolysis Bullosa which leaves him with very thin skin
that cannot tolerate shear forces and is susceptible to infection.
Indeed, it was infection that led to the loss of the limb. He also has
substantial scarring in the inguinal region due to an investigation for
cancer of the lymph glands. Further complicating the situation is the
fact that he is also essentially a bilateral partial hand amputee as all
the fingers have been fused and partially amputated, and the skin is
very fragile to the point where he experiences skin breakdown just using
the parallel bars. This reduces his ability to pull anything on strap
anything up and even impairs his ability to don the prosthesis and needs
help doing so.
Presently he's wearing a full suction socket with flexible inner liner
and a TES style waist belt, incorporating a Total knee and Trias foot.
Stability is his main issue but weight is also an issue and I've
attempted to make things a light as possible to reduce the shear forces
on his skin. I've be successful in getting him to walk without skin
breakdown, however, he does feel that the socket comes loose or makes
noise at the time one would typically expect ( standing from sitting,
etc.). I would like to improve the suspension, He's asked about pin
liners etc, my concerns are that with such a short residuum a pin liner
would put too much shear force onto the tissues and that we'd have even
more issues trying to get the liner on consistently. Plus the material
of the liner would be a concern as accumulation of bacteria would
increase the potential for infection which he is already at higher risk
for.
If anyone has any experience with situations such as this I would
greatly appreciate any input that would help me to come up with
something that will allow this individual to achieve maximum possible
mobility. Please don't hesitate to contact me if you need any further
information.
Thank you in advance.
Steve Scott, CP(c)
Cascade Prosthetic Services.
403-283-2979.
Citation
Steve Scott, “Difficult Case,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/233165.
