PubMed · 5944647
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J E Lescoeur. 1966-04-15. [Thoughts on amputation stumps].. https://pubmed.ncbi.nlm.nih.gov/5944647/
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Arthroscopic revision of intra-articular infection is more and more accepted. To our knowledge, there is no description of endoscopic management of an infected amputation stump. This paper presents the case of a 54-year-old man after a Syme amputation of his left leg because of diabetic gangrene of the foot. A local infection of the stump was treated successfully with two endoscopic debridements and lavage. Additionally, the patient received local antibiotics by the application of antibiotic collagenous fleece and chains. This therapeutic management combined with early weight-bearing produced a stable stump.
Dermatologic disorders of the stump in patients with a leg amputation may have characteristic pathophysiologic and clinical features. A knowledge of these factors may lead to earlier diagnosis and avoid immobilization. There ist no German language review of this aspect of dermatology. After providing an overview of the problem, including a discussion of prostheses, we review the following problems: mechanically induced blisters, follicular keratoses, epidermoid cysts, stump edema syndrome, acroangiodermatitis (pseudo-kaposi sarcoma) and verrucous hyperplasia.
The frictional action at stump/socket interface is discussed by a simplified model and finite element model analyses and clinical pressure measurements. The friction applied to the stump skin produces stresses within tissue and these stresses may damage the tissues and affect their normal functions. The combination of normal and shear stresses is considered to be a critical factor leading to amputee's discomfort and tissue damage. However, friction at the stump/socket interface has a beneficial action. A simplified residual limb model and a finite element model using real geometry have been developed to analyse the support action of friction. Both results show that the friction plays a critical role both in supporting the load of the amputee's body during the support phase of the gait cycle and in preventing the prosthesis from slipping off the limb during swing phase. Pressure at the below-knee socket during walking were measured with conditions of different friction. The results reveal that a larger pressures was produced at the lubricated interface than at the normal interface. A proper choice of coefficient of friction will balance the requirements of relief of load stress and reduction of slip with the general ability to support loads.