PubMed · 2811777
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R B Patt. 1989. Postamputation pain.. https://pubmed.ncbi.nlm.nih.gov/2811777/
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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.
Instrumentation to measure accurately the stresses at the interface of a residual limb and prosthetic socket has a strong potential for use in prosthetic treatment. As a tool in the clinical setting, the device would allow a clinician to identify sites of excessive loading, information which could then be combined with clinical assessment of skin quality to determine regions of potential skin breakdown. Stress distributions for different prosthetic designs could be compared, facilitating a clinician's judgement to determine the optimal design for a patient. The instrumentation would have additional use in research as an evaluation tool for computer-based finite-element (FE) models. Stump-socket FE models predict stress distributions for proposed socket designs, thus offering advantages over interface stress measurement because evaluation can be conducted before a prosthesis is fabricated or put on an amputee patient. However, FE models must first be proven valid against experimental measurements before they can be considered accurate predictors of interface stresses. Current interface stress measurement techniques are described, with a concentration on a physical explanation of the advantages and limitations with each technique. New emerging technologies are discussed which are instruments that have been described but for which no data collected on amputees have been reported in the literature. The important new features of those technologies are also discussed.
A skin-stretching device (SSD) which is designed to harness the viscoelastic properties of the skin using incremental traction is described. It has proved to be of value in securing closure, within 72 h, of an open high below-knee guillotine stump wound which did not heal during a period of 2 months after amputation. The skin-stretching device provided healthy, durable and sensate skin for stump coverage. Hospitalization time was shortened and an early post-surgical prosthetic fitting and ambulation was achieved.