The Amputee's Stump: Area Needing Attention

Researchers from Uniformed Services University of the Health Sciences in Bethesda, MD, have published a review of amputation stump-related issues to which endocrinologists can refer.

Researchers from Uniformed Services University of the Health Sciences in Bethesda, MD, have published a review of amputation stump-related issues in the September-October 2014 issue of Clinics in Dermatology. Endocrinologists can refer to this review for guidance on identifying types of stump problems, origins, and possible solutions.

Approximately 2 million Americans live with limb loss, with approximately half of all amputations due to vascular disease, especially diabetes.

In ordinary amputations, the surgeon removes the limb, transposes skin and muscle flaps over the stump, and sometimes inserts mechanisms that allow the patient to attach a prosthesis. Clearly, skin, nerve, lymphatic, musculoskeletal, and vascular elements are disturbed. The resultant stump site needs time to heal and requires life-long care to prevent skin irritation and disease.

When patients attach prostheses, the device causes stump compression and contact friction. Additionally, humidity and moisture result at the contact site. In patients who may already have vascular disease, diabetes, or malignancy, the consequences can be dire, leading to severe infection and the need for revision. Dermatologists call the local immune disregulation on the terminal end of the stump, “an immunocompromised district.”

Immediately after surgery, edema is a challenge that affects prosthesis fit. Later, skin thickness and integrity is a concern. Volar skin found on the palms and soles is adapted to withstand compression and friction. Stump skin is not. When the prosthesis moves, it creates forces that aggravate the stump skin’s softer texture. If the patient’s discomfort is not addressed and resolved, he or she may have to abandon the prosthesis.

Researchers are developing interventions to increase the stump skin’s adaptability and durability to reduce the likelihood of skin breakdown, infections, tumors, and malignancies.

The university’s article summarizes common inflammatory and noninflammatory skin diseases that occur at the stump, many of which are related to trapped perspiration. Among the recommendation are those that a medical provider would expect — antibiotics, rest, steroids and heat or cold — and those that are unique to amputation like laser hair removal and botulinum toxin injections to reduce perspiration.

The authors emphasize good hygiene and checking the prosthesis fit often. With good care, prosthesis-related issues can be minimized.