Tuesday, July 16, 2024

[OANP-L] TF limb acne

Rick

 Hello all !
Working with a fairly new prosthetic user (in his prep 5months).   He’s been dealing with painful white-head pimples scattered about his residuum.  He perspires very heavily & says he always has.  He has the hairiest residual limb I have ever seen; more hair than most guys over 60 have on their heads!  Hair length is also extraordinary at near 2″ long about the distal posterior 4-5″ of the limb.  The amputation was odd in that an Anterior flap was folded over distal end & the incision lies approximately 4″ up from end.  This particular surgeon also left 5″ of redundant tissue distal to the cut end of femur & “proudly told” pt & his family how he left him a “…very nice bird’s nest for the femur to nestle in”…!!?!    NEVER heard of that before.  Apparently the entire length of thigh muscles were retained & sewn together in this blob!   So far the socket has controlled this, but his KC will always be noticeably lower.
I digress…pt’s pimples look exactly like teenager acne.  They are not clustered like a rash or prickly heat, they are not blotchy about the limb like a fungal infx & they are not uniformly covering his limb like an allergic Rxn to the gel liner or the soap used to clean his liners.  They do not smell, but they do itch & are painful to the touch.   Dr. originally put him on oral antibiotics.  Nothing.  Someone else suggested some sort of ointment.  Nothing.  Another medicated cream- nothing.  He has been using an antiperspirant to help limit perspiration.  Pimples are the same with or w/o the antiperspirant…maybe slightly worse about distal end w/the excessive sweating.  Currently a new Dermotologist Rx’d a hydrocortisone cream.  This is helping, but in one week of use, has not diminished the pimples enough to satisfy the pt.
pt is using Ossur TF locking liners.  Alternates wear btwn two daily as instructed.  Washes liners each night when finished for the day.  Uses a mild soap & wash cloth to wash inside & out of liners.  Rinses thoroughly.  He has tried 3 different soaps for cleaning his liners & residuum & feels a Dove soap bar causes less pimple issues.  Usually half way through his day, he doffs his prosthesis & liner to dry limb & liner due to sweating.  Says some days he will even wash his limb thoroughly, wait an hour then redon his prosthesis for the rest of his day.  Notices nothing different in pimple population.  Kept his prosthesis off for a 3days weekend earlier this Spring & pimples diminished & became less painful.  He does not want to just sit around not using his prosthesis.  This 60-something dude wants to workout every day & is especially found of cardio-workouts.  Frustration is growing.
Thoughts…?
Thank you.Rick
Rick Milen, L/CPONEXSTEP, Inc.West Lawn, PAandZombie Buck DesignzBernville, PA

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