Skin-to-Skin Match?

Web Development inMotion

Volume 14 · Issue 1 · January/February 2004 | Download PDF

by Christina DiMartino

Product Advances Make It Possible

Skin 01Miami, Florida, resident Lila Rodriguez had her right leg amputated below the knee as the result of complications resulting from advanced diabetes. A couple of years later, she had adjusted to her prosthesis and returned to a normal routine in life.

“I don’t consider myself a vain person, but I admit having somewhat of a difficult time getting used to the occasional stares I got before being fitted with my prosthesis,” Rodriguez says. “Having it helped increase my confidence as well as my mobility. As time passed, however, one issue continually bothered me: The color of my prosthesis was considerably lighter than my skin color. My heritage is Spanish, and my skin tone is relatively dark, even more so than typical Hispanic skin tones. I prefer to wear dresses and skirts rather than trousers because it is easier for me to dress and undress. Besides, I live in a very warm climate so skirts are cooler and more comfortable. Consequently, my ‘lighter leg’ is always ‘out there’ drawing attention. I have gotten used to my prosthetic leg, however, and, other than wishing it looked better, I have no need or desire for a new one at this time.”

Rodriguez is just one of thousands of people with an amputated limb who admit that they feel they would be happier and less self-conscious if their prosthetic limb matched their natural skin tone better. Few, however, realize that achieving this is a much more complex issue than simply painting the prosthetic limb the right color.

Until recent years, prosthetists around the world used the same basic system to match prostheses to skin colors. During the fitting process, a pallet of approximately 20 or so colors was placed next to the patient’s sound side, and the closest match was chosen. Though this is still the most common procedure, technological and material advances now provide people with options that weren’t available a few years ago. New “skin” materials on the market today not only match skin  tone and texture amazingly well, they can have veins, freckles and hair painted on them for an even more natural look. Most of these new skin products are made from silicone.

Michael Kaczkowski is the director of anaplastology for Alatheia Prosthetics in Brandon, Mississippi. The company makes custom matched prosthetic skin called Dermatos, which he says translates to “of skin” in Greek.

Skin 02“Dermatos is an entire process adaptable for fabrication into prostheses as small as a fingertip or as large as an entire leg,” Kaczkowski says. “It is even made into skin covers that protect and enhance the gripping power of bionic and body powered hands. It simulates the visual properties of each human skin layer it represents.”

In real human skin, the epidermis layer (the outer layer of skin) has fingerprints and skin details, Kaczkowski explains. It also contains pigment called melanin. When skin is exposed to the sun, more melanin is created to help counteract the sun’s damaging rays. The goal in developing products that simulate real skin better is to recreate the details that give natural skin its unique characteristics.

Kim Doolan is the public relations coordinator for Aesthetic Concerns Prosthetics, Inc., the manufacturers of LIVINGSKIN. The company makes its own prostheses as well as silicone skin coverings that can go over prostheses made by other companies.

“LIVINGSKIN is a silicone product,” Doolan says. “It is custom-sculpted and painted by our artisans to match the patient’s sound side. If patients are able, they come to one of our facilities in Chicago, Atlanta, Toronto or Middletown, New York. Those who cannot come in person, however, can still have customized silicone skin made for their prosthetic limb. We send a camera and full instructions on how to take the pictures to the prosthetists, and our technicians paint from the photographs. We have great success this way.”

The LIVINGSKIN process includes a clear layer of silicone on the outside that mimics the epidermal layer. Using very long paintbrushes, the artists paint from the inside in a sort of “inside-out” process. Several different colors are used because skin tone is not one consistent color but a mixture of textures and colors. Skin around the knuckles, for example, usually has more red pigment, as do palms. The palm of the hand is also commonly lighter in color than the back of the hand and the arm. Through long and intense experience and education, the technicians, who are truly artists in their field, have learned which shades of paint to use and how thick each one should be applied.

Skin 03“I don’t know if more men or women are ordering customized skin products today,” Doolan says. “But it is interesting to know that all the hand transplants that have been done in the world have been on men. Part of the reason may be size. Men’s hands are typically larger than women’s, and, therefore, their vascular systems are larger and easier for surgeons to operate on. The vanity issue may also have something to do with it. Men seem to be more subconscious about their hands.”

ARTech Laboratory, Inc., in Midlothian, Texas, makes only the customized skin coverings that go over the prosthetic limb. Mike Holt, the company’s president and co-owner, says the company also uses a silicone product.

“About 80 percent of our business is done through the mail using photographs,” Holt says. “We work directly with prosthetists and find that the photograph system works exceptionally well.”

Holt says it is possible to match a sound side “freckle to freckle and hair to hair.” The “hair” is painted on, but it matches the natural hair on the sound side of the body in color, thickness and length.

Skin 04“You can actually see the skin come to life during the painting and detail process,” he says. “When patients see the finished product, they are in awe of how perfectly a prosthetic limb can now match their own skin. Although we don’t often meet the patient in person, we receive a lot of mail from them offering their gratitude and appreciation.”

In addition to complaints by people that the prosthesis they use looks artificial and monotone in color, people commonly complain that their prosthesis stains easily. However, elements that stain typical products used to make prostheses, such as newspaper ink, wash off easily and completely from silicone-based products. Silicone skin works exceptionally well for legs, feet, toes, arms, hands and fingers. It can also be used on most types of prostheses, including myoelectric and body-powered limbs.

There is even better news for people like Lila Rodriguez who are happy with the fit of their socket or prosthesis. Most silicone based skin can be retrofitted over most existing prostheses without altering the fit. This means that these people can keep their present prosthesis with the option of having a skin covering made to match their natural skin perfectly.

Even better news, especially for people like Rodriguez who live in the “Sun Belt,” is that a “tanning” solution is available from some silicone skin manufacturers that allows wearers to gradually deepen their tans to match the rest of their body. Imagine – all of this and a suntan to boot!