Skin problems of the leg amputee.

Introduction Lower-extremity amputees, the group with which this paper is concerned, include persons who have been subjected to gross anatomic loss of the lower limbs at widely varying levels, such as partial foot amputation, below-knee and above-knee amputations, knee or hip disarticulation, and hemipelvectomy. Amputation at each level is attended by distinctive problems of functional loss, fitting and alignment of the prosthesis, and medical difficulties, such as skin disorders, that are secondary to the use of the limb. These amputees require the continued care of prosthetists who construct the artificial limbs on which the amputees must depend for locomotion—and indeed, to a large degree, for social and economic rehabilitation—for the rest of their lives. But the problems facing leg amputees are not wholly prosthetic. Many are clearly medical; for example, pain, circulatory problems, and skeletal changes. Many amputees also require the care of the dermatologist more or less frequently throughout their lives. The dermatologist is capable of rendering invaluable aid to the other members of the rehabilitation team, since he is in a position to be familiar with the problems of the skin that may result from wearing an artificial limb. The skin of an amputee who wears a prosthesis is subject to many abuses. Most leg prostheses have a snugly fitting socket in which air cannot circulate freely and perspiration is trapped. The socket provides for weight-bearing; uneven loading may cause stress on localized areas of the stump skin. Examples of such stress are