title: Improper use of a transtibial prosthesis silicone liner causing pressure ulceration.
abstract: We present the previously unreported hazard of creating pressure ulceration in a susceptible host by the improper use of a silicone prosthetic liner. An 80-yr-old man sustained a recent transtibial amputation for peripheral vascular disease. His comorbidities included vascular cognitive impairment, type 2 diabetes mellitus, coronary artery disease, anemia of chronic disease, postherpetic neuralgia, and pruritus of uncertain origin. When not using his transtibial prosthesis, he found his 1.5-mm thick silicone liner (ICEROSS) more comfortable to wear than his stump shrinker and thermoplastic protector. Moreover, he repeatedly wore his liner rolled partway down his stump to allow him to scratch pruritic skin. A horizontal, linear, stage 2 ulcer developed on the residual limb under the upper edge of the rolled liner. The ulcer required >3 mos to heal. This case illustrates the importance of candidate selection for roll-on liners, proper patient and professional training, and optimal management of patient comorbidities.
authors.affiliation: Division of Physical Medicine and Rehabilitation, Department of Medicine, Dalhousie University, QEII, Nova Scotia Rehabilitation Centre, Halifax, Nova Scotia, Canada.
authors.forename: Tania R
authors.initials: TR
authors.lastname: Bruno
authors.forename: R Lee
authors.initials: RL
authors.lastname: Kirby
mesh_terms: D000369:Aged, 80 and over; D000672:Amputation Stumps / Q000473:pathology*; D001186:Artificial Limbs / Q000009:adverse effects*; D004643:Emollients / Q000627:therapeutic use; D006801:Humans; D008297:Male; D010577:Petrolatum / Q000627:therapeutic use; D003668:Pressure Ulcer / Q000209:etiology* / Q000628:therapy; D012828:Silicones / Q000009:adverse effects*; D013977:Tibia
chemical_list: D004643:Emollients; D012828:Silicones; D010577:Petrolatum