Pressure ulcers are areas of tissue damage that occur when the skin is subjected to prolonged pressure. For individuals using lower-limb prostheses, the skin on the residual limb, which interfaces with the prosthetic socket, is particularly susceptible to mechanical stresses such as compression, shear, and friction. These forces can compromise blood flow, reducing the delivery of oxygen and nutrients to the tissue, and obstructing lymphatic drainage—which is essential for waste removal and infection prevention. The result is localized skin and tissue damage that can lead to tissue death or necrosis.1
In lower-limb prosthesis users, several factors contribute to the development of pressure ulcers. First, unlike the skin on the sole of the foot, the skin on the residual limb is not meant to withstand the high pressures from walking, making it more vulnerable to damage. Additionally, excessive moisture from perspiration within the prosthetic socket can further macerate the skin, lowering its resistance to injury. The anatomical characteristics of the residual limb, such as thin muscle flaps, limited subcutaneous fat, and prominent bony areas can exacerbate the risk of ulceration.2 Lastly, the design of the prosthetic socket and the choice of components are crucial for managing the pressure and friction on the residual limb, which are key factors in ulcer formation.
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