Bruno Tania R, Kirby R Lee
Division of Physical Medicine and Rehabilitation, Department of Medicine, Dalhousie University, QEII, Nova Scotia Rehabilitation Centre, Halifax, Nova Scotia, Canada.
Am J Phys Med Rehabil. 2009 Apr;88(4):264-6. doi: 10.1097/PHM.0b013e31818dfdc9.
We present the previously unreported hazard of creating pressure ulceration in a susceptible host by the improper use of a silicone prosthetic liner. An 80-yr-old man sustained a recent transtibial amputation for peripheral vascular disease. His comorbidities included vascular cognitive impairment, type 2 diabetes mellitus, coronary artery disease, anemia of chronic disease, postherpetic neuralgia, and pruritus of uncertain origin. When not using his transtibial prosthesis, he found his 1.5-mm thick silicone liner (ICEROSS) more comfortable to wear than his stump shrinker and thermoplastic protector. Moreover, he repeatedly wore his liner rolled partway down his stump to allow him to scratch pruritic skin. A horizontal, linear, stage 2 ulcer developed on the residual limb under the upper edge of the rolled liner. The ulcer required >3 mos to heal. This case illustrates the importance of candidate selection for roll-on liners, proper patient and professional training, and optimal management of patient comorbidities.
我们报告了因不当使用硅胶假体衬垫而在易感宿主中造成压疮这一此前未报道的危害。一名80岁男性因外周血管疾病近期接受了经胫骨截肢手术。他的合并症包括血管性认知障碍、2型糖尿病、冠状动脉疾病、慢性病贫血、疱疹后神经痛以及病因不明的瘙痒症。在不使用经胫骨假肢时，他发现自己1.5毫米厚的硅胶衬垫（ICEROSS）比残肢收缩袜和热塑性保护器穿着更舒适。此外，他反复将衬垫卷到残肢的一半位置以便能搔抓瘙痒的皮肤。在卷起的衬垫上缘下方的残肢上出现了一个水平的、线性的2期溃疡。该溃疡需要超过3个月才能愈合。此病例说明了选择可卷式衬垫的合适人选、对患者和专业人员进行适当培训以及对患者合并症进行最佳管理的重要性。
