> Date: Wed, 16 Jan 2008 12:32:20 -0800
> From: [email protected]
> Subject: [OANDP-L] BK skin issues
> To: [email protected]
>
> Hello,
>
> My name is Jonathan Roskos. I live in Los Angeles. This email address was give to me by my prosthetist, David Cooney at Beverly Hills Prosthetics and Orthotics. If I need to register, please send me the form/info at this email address. If not, my question:
>
> Does anyone out there have experience with laser removal of the hair follicles on the stump when they persistently become infected and uncomfortable? I have had skin that is prone to what I can best describe as cystic acne since puberty. It has been the greatest source of discomfort and discontent with my prosthesis for the past 3 or 4 years. My left foot and calf were amputated six years ago due to trauma, when I was 19. I have about 1.5 inches of tibia, and 1 inch of fibula, my knee does not bend past 90 degrees.
>
> Laser hair removal only advertises hair count reduction by 40 to 80 percent. This makes me wonder if the follicles that were getting infected in the first place would continue to become infected. I also wonder if the irritation could potentially worsen my situation in some unforseen way. Any thought and, especially, experience with this would be extremely helpful to me.
>
> I had a bursa removed from my stump about 6 months ago, and the way is flaring up now makes me think I am headed for a similar procedure. I have had two minor surgeries on the skin of my stump in the past 3 years to remove or drain what started as infected hair follicles. With the bursa, I was on crutches for a month after the surgery, and I would like to avoid that happening again if possible.
>
> I use an Alpha liner with suction system now, thinking that would help cut down on friction between my stump and liner (I formerly used an alpha locking liner), but the problem persists. I also use iodine on my stump every night and alcohol on my liner regularly.
>
> Thank you in advance for any responses,
> Jonathan Roskos
>
>
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Hello Johnathon,
I have had experience with laser hair removal with one of my patients.
The
individual is an avid cyclist and competative triathlete that suffered
from reccurent bouts of inflamed hair follicles for several years
before
electing to have the hair laser removed from his residual limb
(transtibial amputee). Secondary to the procedure he has not had any
recurrence to my knowledge, and he is several year post procedure.
The individual lives upstate from you. Though I have since moved form
the
area I will attempt to contact him if you would like to speak with him.
Take care and good luck to you in your future endevors.
Eric O’Guinn, CPO
I am a Certified prosthetist, and also a BK amputee. I got into this field about 9 years ago, at age 33, after having an accident that resulted in the amputation of my left foot and lower leg.
I also had problems with some ingrown hairs, infected hair follicles, or whatever the real issue was. I did have the laser hair removal on my leg, going all the way to my hip basically, so that when I wear a knee sleeve, that skin is as smooth as possible to maintain suction and not let the hair kind of wick the air underneath the sleeve.
The process basically takes 4-6 visits and treatments, where they go over the skin with the laser (or more accurately referred to as an intense light source, and not really a laser), and it kills the follicles over the course of the treatment. It is more effective on the darker, coarse hair, and will not have any effect on the light, thin hair. After the treatments are over, you will (or should) see a major reduction in the amount of the dark hair, and only have the thin, light hair that will continue to grow, which is generally not the hairs that cause the problems anyway. I still have the lighter hair growing on my leg, which is just fine. After having this procedure done, I have had no more problems with the infections or problems. I have had a couple patients also do this treatment, which has greatly helped them as well.
I cannot guarantee that you will have the same kind of results, it doesn’t sound like I had nearly the issue that you have to start with, but I did have some problems, and now that is over with.
The procedure is not pain-less by any means. It is sensitive and pretty uncomfortable to go through, like having a hot rubber band snapped on your skin over and over during the process. If you have access to any pain medication, that helps to take the head off the pain or discomfort during the procedure or treatments. I always took something about 30 minutes before the treatment so that I could tolerate it better, and it sure helped. The first one I didn’t take anything, not knowing what I was in for. It isn’t THAT bad or horrible, but it isn’t fun either.
I would be happy to help you with more information if you have any questions.
Good luck with this.
Jim DeWees, CP
Jonathan,
I had a patient with a similar situation. Like you, we took him out of
the pin system and put him into a suction that helped tremendously.
Also, we changed liners from the mineral spirits based Alpha and into a
silicone liner and that has solved his problem. The length of your
residual limb is a concern. Not knowing your weight, your limb does not
have a lot of surface area to bear your weight and as a result more
irritation.
I hope this helps.
David Mitchell, CPO
Practice Manager
Hanger Prosthetics and Orthotics, Inc.
Lawrenceville, Ga.
770-963-7046(office)
770-339-7720(fax)
770-314-9725(cell)
Mr. Roskos,
Antibacterial soap such as Dawn or Palm Olive should be used to clean
the liner daily. Alcohol alone will not help you. It doesn’t cut through
the oils deposited by your skin. Dish soap is designed to cut through
grease and rinse away completely. Might want to think about a different
liner setup as well. I know several guys with the same situation as
you and they all use silicone liners of some sort. Alpha gel is a mineral
oil, it is not inert, and it does break down over time (as the
molecules in it work harden). I like ossur liners because they have a mellow
silicone that helps keep the skin soft and supple, and they are soft and
comfortable without sacrificing control of the leg. Other things to
consider are socket design, and consequently, irregular pressures within
the socket.
Good luck,
Matt Daniels, CP
Clinical Branch Manager
Hanger Prosthetics and Orthotics
Quincy, IL
Patient Name:
Side:
Level:
Work:
Date Req’d:
Practitioner: Matthew C. Daniels, CP, PM
Delivery Address:
Hanger P&O
307 North 36th Street
Suite 204
Quincy, IL 63201
Avante #: 5612
Thank you very much,
Matthew C. Daniels, CP
(response to Jonathan Roskos’ question as to which Absorbine Jr. product to use and when)
The original strength applied both at night and in the morning prior to wearing the limb. It’s also a great cooling agent during the day. Wait for it to dry completely before donning the prosthesis. Keep me posted.
Ronnie N. Graves BOCPO, CO, LPO, RTP
Prosthetics Research Specialists, Inc.
720 East Southland Ave
Bushnell, Fl 33513
352-793-4477 Work
352-603-4249 Cell
352-793-1448 Fax
Just wanted to comment on the laser hair removal. I
am not an amputee, I am a currently a prosthetist
student =).
I have had Laser Hair removal on the lower part(knee
down) because of the same problem. I’ve had horrible
folliculitus since I started shaving when I was a
teen. Infections and scarring, embarrassing to a girl
ya know.
I have only had two treatments so far but the
folliculitus is about 95% gone and I notice a
considerable decrease in the amount of hair growing
back. They say you need 6-10 treatments in a timed
schedule(usually every 10-12 weeks) for it to be
“permanent”. You also need to have dark hair. It
your hair is blond it won’t work. Another piece of
advice is that it was ridiculously painful (for me)
but for just your residual limb it would probably only
take 10 minutes. Ask for numbing cream before you get
there and lather it on and cover with syran wrap for
at least an hour(embula I think is what it’s called).
Finally, if you choose to have it done, don’t freak
out when nothing at all happens for almost 2 weeks. I
was really mad and thought it didn’t work, then about
2 or 3 weeks later it just all fell out. I know it
doesn’t answer your specific question regarding your
residual limb, but I hope it helps you a little bit.
Also make sure that it is a plastic surgeon or a nurse
doing the lasering, not some Joe Schmo trying to make
some cash. Good luck.
Jessica
it might work, might not. i am assuming you have skin irritation/hair follicles irritation due to liner “tack” to skin. so, what i quite successfully did many times, is try using either nylon hose with toe in it (ask your prosthetist for vacuum forming hose with toe, we all have stash of those in the office) or a single, even 2 ply sheeth – against your skin, then donn liner over it.
you will not lose suction or suspension, we had very active patients set up like this with no adverse effects, unless a very profound perspiration occurs. but this helped many who have sensitive skin and all kinds of skin problems relevent to some sort of gel liner use.
also, you might try switching to TEC liner, as it has very low coefficient of friction against skin.
sincerely,
i. lesko, l/cpo
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