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LAS VEGAS — Managing soft tissue is crucial for proper fit of a lower limb prosthesis, according to Christian Ertl, MD, a general surgeon and wound specialist at Michigan State University Kalamazoo Center for Medical Studies, who presented at the Hanger Education Fair and National Meeting, here.

According to Ertl, after an amputation, wound management is the first step for ensuring proper healing and an ideal prosthesis fit.

“Wound care complications means delaying prosthetic fit,” Ertl said.

Clinicians should evaluate skin color and temperature and watch for any turgor or inflammation to assess if the wound is properly healing.

Once the patient’s wound has healed, excessive or uneven soft tissue on the residual limb can present challenges when trying to fit the patient with a prosthesis.

“Sometimes if there is a lot of soft tissue left, there can be a fitting issue,” Ertl said. “Liners can help contain the skin, but not always.”

Ertl recommended using visual cues, gait force analyses and imaging when fitting a patient. Clinicians should dynamically assess weight bearing responses and total contact as the patient is sitting and standing, as well as evaluate the unaffected limb when fitting the prosthesis. This can also help determine if uneven or excess soft tissue is indicative of any other issues that may require surgical intervention.

Ertl also recommended utilizing a team of surgeons and therapists when dealing with challenging fittings.

For more information:

Ertl C. Soft tissue management in lower extremity amputations. Presented at The Hanger Education Fair and National Meeting; Feb.5-7, 2013; Las Vegas.

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