title: INTERVENTIONS TO MANAGE RESIDUAL LIMB ULCERATION DUE TO PROSTHETIC USE IN INDIVIDUALS WITH LOWER EXTREMITY AMPUTATION:A SYSTEMATIC REVIEW OF THE LITERATURE.
abstract: Patients with lower extremity amputation (LEA) experience 65% more dermatologic issues than non-amputees, and skin problems are experienced by ≈75% of LEA patients who use prostheses. Continuously referring LEA patients to a dermatologist for every stump related skin condition may be impractical. Thus, physical rehabilitation professionals should be prepared to recognize and manage common non-emergent skin conditions in this population. The purpose of this study was to determine the quantity, quality, and strength of available evidence supporting treatment methods for prosthesis-related residual limb (RL) ulcers. Systematic literature review with evidence grading and synthesis of empirical evidence statements (EES) was employed. Three EESs were formulated describing ulcer etiology, conditions in which prosthetic continuance is practical, circumstances likely requiring prosthetic discontinuance, and the consideration of additional medical or surgical interventions. Continued prosthetic use is a viable option to manage minor or early-stage ulcerated residual limbs in compliant patients lacking multiple comorbidities. Prosthetic discontinuance is also a viable method of residual limb ulcer healing and may be favored in the presence of severe acute ulcerations, chronic heavy smoking, intractable pain, rapid volume and weight change, history of chronic ulceration, systemic infections, or advanced dysvascular etiology. Surgery or other interventions may also be necessary in such cases to achieve restored prosthetic ambulation. A short bout of prosthetic discontinuance with a staged re-introduction plan is another viable option that may be warranted in patients with ulceration due to poor RL volume management. High-quality prospective research with larger samples is needed to determine the most appropriate course of treatment when a person with LEA develops an RL ulcer that is associated with prosthetic use.
authors.affiliation: School of Physical Therapy & Rehabilitation Sciences, University of South Florida, Tampa, FL, USA; Extremity Trauma & Amputation Center of Excellence (EACE), U.S. Department of Veterans Affairs, Tampa, FL, USA; 319 Minimal Care Detachment, U.S. Army Reserves, Pinellas Park, FL, USA.
authors.forename: M Jason
authors.initials: MJ
authors.lastname: Highsmith
authors.affiliation: OP Solutions, Tampa, FL, USA; Prosthetic Design + Research, Tampa, FL, USA.
authors.forename: Jason T
authors.initials: JT
authors.lastname: Kahle
authors.affiliation: Prosthetics and Sensory Aids Service, James A. Haley Veterans' Hospital, Tampa, FL, USA.
authors.forename: Tyler D
authors.initials: TD
authors.lastname: Klenow
authors.affiliation: School of Physical Therapy & Rehabilitation Sciences, University of South Florida, Tampa, FL, USA; Physical Medicine & Rehabilitation Service, James A. Haley Veterans' Hospital, Tampa, FL, USA.
authors.forename: Casey R
authors.initials: CR
authors.lastname: Andrews
authors.affiliation: School of Physical Therapy & Rehabilitation Sciences, University of South Florida, Tampa, FL, USA.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Lewis
authors.affiliation: Physical Medicine & Rehabilitation Service, James A. Haley Veterans' Hospital, Tampa, FL, USA.
authors.forename: Rachel C
authors.initials: RC
authors.lastname: Bradley
authors.affiliation: Department of Chemistry, University of South Florida, Tampa, FL, USA.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Ward
authors.affiliation: Shimberg Health Sciences Library, University of South Florida, Tampa, FL, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Orriola
authors.affiliation: Dermatology Service, James A. Haley Veterans' Hospital, Tampa, FL, USA; Dermatology Surgery Institute, Lutz, FL, USA.
authors.forename: James T
authors.initials: JT
authors.lastname: Highsmith
keywords: Decubitus ulcer; Dermatopathology; Hot spot; Prosthesis; Rehabilitation; Skin