Basic tips on caring for your skin (Always consult your physician or prosthetist if sores or blisters erupt, which can lead to ulcers and serious infections.)

For your prosthesis to work at maximum efficiency, your socket needs to fit your residual limb intimately. This is called a "total contact" socket, and fabricating this socket requires the skills of a prosthetist. Though sockets are usually made of flexible materials, often they are limited in their ability to flex and change shape while maintaining support. However, if you have a major change in the shape of your residual limb, the socket has to have one, too, to avoid the complications of friction and pressure that can cause sores, blisters and even serious ulcers and infections. Comfort in a prosthetic socket depends on:

• Maintaining a good fit
• Correct alignment
• Skin care

Fit and alignment are the responsibility of your prosthetist; however, he or she cannot help you unless you tell him or her when something is wrong. The first rule, therefore, is "Communication."

Skin care is the responsibility of the individual. There are a few basic rules, the first of which is cleanliness. Remember that your residual limb is encased in a completely - or partially - airtight socket, which does not breathe or allow sweat to evaporate. Sweat is acidic and salty and, when allowed to dry, forms tiny crystals (like sandpaper) on your skin. If this sweat is left on the skin and socket, bacteria can grow, and if the skin is broken, infections may occur, which can become severe if left untreated.

To avoid skin problems, follow these steps:

• Every day, or more often if necessary, wash the residual limb with a mild or antibacterial soap and rinse well.
• Every day, wash everything in contact with your skin with a mild or antibacterial soap and rinse well. This includes socks, nylon sheaths, silicone suction sockets, gel inserts and flexible or hard sockets. Note the manufacturer’s instructions for cleaning and follow closely.
• Do not shave your residual limb. Shaving can cause ingrown hairs, and often leads to infected hair follicles.
• Only use softening creams when your skin is at risk of cracking or peeling.
• Do not use alcohol-based products on your residual limb; they dry out the skin, can cause cracking or peeling, and create a potential site for infection.
• If you must cover an abrasion, use the thinnest dressing possible. If the abrasion was caused by pressure, adding a bulky dressing will increase the pressure.
• Do not add soft materials such as wool to "pad" a sore spot. This will only add more pressure.
• Be aware of how your socket fits. Adjust sock ply if appropriate. If you cannot maintain a good fit, visit your prosthetist.
• Try to maintain the same body weight. A gain or loss of five pounds should be manageable; more than that will probably require a prosthetic adjustment.

If a problem does occur, it usually falls into one of the following categories:

• Rash
• Blister
• Ulcer
• Infection, local or disseminated
• Verrucous (wartlike) hyperplasia

First, visit your prosthetist. The problem c n usually be solved with a prosthetic adjustment. If you have an ulcer or infection – or if you have diabetes or circulatory disease and have anything more than a mild rash – consult your physician immediately. The following treatments are short-term. Problems that persist require help from both your physician and prosthetist.

Rashes

A rash can be caused by either an allergic reaction, often to your own sweat, or a fungus, similar to athlete’s foot. It occurs more frequently in people who perspire heavily and use heavy suction liners.

To avoid rashes:

• Wash and rinse limb and liner every day.
• Lightly dust the residual limb with a medicated talc powder such as Gold Bond at night, and, if this is not contraindicated by the manufacturer, before donning your liner. (Ammens is preferred by some because it does not contain talc.) Suction will not be affected as long as the dusting is light.

Or

• Use a light film of diaper rash cream such as Balmex at night and under the liner if not contraindicated by the manufacturer. (This has been found to be very effective for small children.)

To treat rashes:

• Use an antihistamine lotion, such as Benadryl, which will usually take care of the rash if it is an allergic reaction.
• If you do not catch the rash quickly enough, you may have to resort to an over-the-counter- strength cortisone cream.
• Use a commercially available athlete’s foot treatment such as Tinactin. Remember, if the rash does not respond within 24-hours, seek medical help. Sometimes, it is necessary to wear a thin sheath under the liner during treatment to allow for a little air flow.

Blisters

A blister can be caused by abnormal pressure or by shearing of the skin against “tacky” silicone or plastic.

To avoid blisters:

• Maintain a good fit; if necessary add or remove a sock during the day.
• Blisters can be avoided by using a commercially available “paint-on” film dressing, such as MedLogic’s LiquiShield, designed to help prevent skin breakdown.

To treat blisters: (individuals with diabetes or circulatory disease should see their physician)

• A surface blister should be left intact if possible. If it opens, keep it clean and covered with a thin layer of antibiotic ointment.
• A line of itchy blisters sometimes appears around the edge of, or inside of, silicone liners, especially in hot weather. A little mineral or baby oil around and under the edge of the liner prevents this. Treat the blisters as above.
• Blisters that occur with above-knee sockets can sometimes be covered with very thin see-through dressings such as LiquiShield.

Ulcers and local and disseminated infections should all be treated by your physician; however, the fit of your prosthesis should also be checked. If the cause of the pressure is removed, the problem will often be resolved without the need for aggressive measures.

Verrucous hyperplasia

This is an itchy, red, raised, circular area on the distal end of a residual limb, caused by suction being applied to the end of the limb. This condition frequently occurs when the socket is too tight and the limb does not make total contact with the bottom of the socket.

To prevent verrucous hyperplasia:

• Maintain a good “total contact” socket fit.

To treat verrucous hyperplasia:

• Remove the cause.

Miscellaneous tips:

Excessive sweating can be reduced by using a strong antiperspirant gel on the residual limb. Apply every night until sweating is reduced, then as often as necessary to control sweating. Do not use this if there are any breaks in skin integrity. A stronger preparation, Drisol, is available by prescription.

About the Author:

Paddy Rossbach, RN, is the former chair of the ACA board of directors (1997-2000). She is currently an ACA consultant in the areas of fundraising and healthcare education.

© Amputee Coalition of America. Local reproduction for use by ACA constituents is permitted as long as this copyright information is included. Organizations or individuals wishing to reprint this article in other publications, including other World Wide Web sites must contact the Amputee Coalition of America for permission to do so.