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Aflatooni S, Beekman K, Hennessy K, Highsmith MJ, Heckman JT, Shumaker PR, Hivnor CM, Beachkofsky TM. Dermatologic Conditions Following Limb Loss. Phys Med Rehabil Clin N Am 2024; 35:739-755. [PMID: 39389634 DOI: 10.1016/j.pmr.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2024]
Abstract
The use of prostheses in individuals with limb loss increases the risk of maceration, friction, and pressure-induced skin injuries due to the vulnerability of the residual limb and the close contact with the socket. Poorly fitting prostheses exacerbate these issues, especially for those with immunosuppression or vascular conditions. Skin pathologies disrupt daily prosthetic limb use and impact the independence of those with limb loss. Preventive measures, including proper prosthesis socket fitting and meticulous skin care, are crucial. This review explores residual limb-site skin pathologies and details current mitigation and management strategies.
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Affiliation(s)
- Shaliz Aflatooni
- Morsani College of Medicine, University of South Florida, 560 Channelside Drive, Tampa, FL 33602, USA
| | - Kate Beekman
- Morsani College of Medicine, University of South Florida, 560 Channelside Drive, Tampa, FL 33602, USA
| | - Kerry Hennessy
- Department of Dermatology and Cutaneous Surgery, Morsani College of Medicine, University of South Florida, 13330 USF Laurel Drive, Tampa, FL 33612, USA
| | - Michael Jason Highsmith
- Orthotic, Prosthetic & Pedorthic Clinical Services (OPPCS) Program Office (12RPS4), Rehabilitation & Prosthetic Services, US Department of Veterans Affairs, 810 Vermont Avenue Northwest, Washington, DC 20420, USA; School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, 3515 East Fletcher Avenue, Tampa, FL 33613, USA
| | - Jeffrey T Heckman
- Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Boulevard, MDC 55, Tampa, FL 33612, USA; James A. Haley Veterans' Hospital & Clinics, 13000 Bruce B. Downs Boulevard, Mailstop-117 Tampa, FL 33612, USA
| | - Peter R Shumaker
- Dermatology Department, US Department of Veterans Affairs, Veterans Administration San Diego Healthcare System, 3350 La Jolla Village Drive, Suite 111B, San Diego, CA 92161, USA
| | - Chad M Hivnor
- Dermatology Department, US Department of Veterans Affairs, South Texas Veterans Health Care System, 7400 Merton Mentor Drive, San Antonio, TX 78229, USA
| | - Thomas M Beachkofsky
- Dermatology Department, US Department of Veterans Affairs, James A. Haley Veterans' Hospital, 12210 Bruce B Downs Boulevard, Building 111H, Tampa, FL 33612, USA.
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Lannan FM, Powell J, Kim GM, Hansen CR, Pasquina PF, Smith DG. Hyperhidrosis of the residual limb: a narrative review of the measurement and treatment of excess perspiration affecting individuals with amputation. Prosthet Orthot Int 2021; 45:477-486. [PMID: 34723907 DOI: 10.1097/pxr.0000000000000040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 07/27/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Hyperhidrosis (HH) is a relatively common disorder involving excessive sweating, typically of the palms or axilla. HH can also frequently occur after limb amputation, where the remaining residual limb excessively perspires, leading to an increased risk of dermatological disorders and functional limitations, such as the inability to comfortably or safely wear a prosthesis. Although many treatments have been proposed to treat HH within the dermatology community, they are not widely known by healthcare providers typically involved in caring for individuals with acquired limb loss. OBJECTIVES To appraise the current state of quantitative and qualitative assessment of HH within the residual limb and examine existing and future treatment strategies for this problem. STUDY DESIGN Narrative Literature Review. METHODS A literature review focused on the assessment and treatment of excessive sweating of residual limbs. RESULTS There is currently no objective or subjective standard to assess or diagnose HH of the residual limb. Conventional therapies for HH do not always translate to the population of individuals with limb loss. Emerging modalities for treating HH show promise toward a permanent resolution of excess perspiration but require additional studies within people with amputation. CONCLUSIONS Further research is needed to quantify standard values to objectively and subjectively assess and diagnose hyperhidrosis of the residual limb. New and developing treatments for hyperhidrosis require additional studies to assess efficacy and safety in the residual limb.
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Affiliation(s)
- Ford M Lannan
- Department of Dermatology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Jordan Powell
- Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Gabriel M Kim
- Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Colby R Hansen
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah
| | - Paul F Pasquina
- Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Douglas G Smith
- Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Orthopaedic Surgery at the University of Washington, Seattle, Washington
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