special subjects
Skin Care of the Residual Limb
Risk factors for skin problems
Disorders that decrease circulation to the lower limbs (such as blood vessel disorders or Diabetes Mellitus (DM) ) and put people at risk of amputation also increase the risk of Some of these disorders (such as diabetes) and others (such as neurologic disorders) impair the ability to feel pain and other sensations. People with such disorders may not feel discomfort or pain when skin breaks down or infection develops and thus do not notice these problems. These people should remove their prosthesis several times a day to check the skin for redness and other signs of breakdown or infection. Other people should check for these signs at least once daily. Skin problems are more likely when the residual limb has certain features, including too much tissue at the end of the bone, loose skin, burned skin, skin grafts, thick or deep scars, and bumps or sharp points on the end of the bone. If the prosthetic socket fits optimally, skin problems are minimal. But even with good fit, normal limb changes such as muscle shrinkage and day to day differences in fluid volume can alter the stump-to-socket relationship and increase risk of problems. If the upper portion of the socket is too tight, circulation is impeded and the limb can swell, which increases pressure over the distal residual limb and risks skin deeper tissue problems. If the socket is too loose, excess pressure will be applied to the end of the limb and bony prominences causing skin problems. 