Hello list,
I am currently seeing a patient who has a genetic condition called epidermolysis bullosa, which causes skin blistering and breakdown in response to any pressure or shear force. She recently underwent a transtibial amputation due to a melanoma on her heel caused by repeated skin breakdown.
We started her out in an alpha locking liner, which worked well at first, but as soon as she washed the liner a few times it started to rub on her skin and caused massive blistering. After wearing the prosthesis in physical therapy for 2 sessions her entire residual limb was covered in open bleeding blisters. We switched her to an Iceross dermo liner with no change in skin condition. We are currently trying the iceross dermo with a plastazote liner and 5 ply sock with pin suspension to try to move the shear force away from the skin.
I’m looking for any ideas or experience you may have in dealing with patients with this condition or any condition that causes very fragile skin. The patient understands she may not be able to be on a prosthesis all the time but she lives in a four story house and absolutely hates using her wheelchair. I also have to emphasize the point that there are really no areas on her body that will not break down under shear force or pressure.
Thank you, and looking forward to your responses.
Marina Musicus, MSPO
Prosthetic resident
U of M Orthotics and Prosthetics Center
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