Buikema Kathryn E S, Meyerle Jon H
Department of Dermatology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
Department of Dermatology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
Clin Dermatol. 2014 Sep-Oct;32(5):670-7. doi: 10.1016/j.clindermatol.2014.04.015.
The stump site of amputees presents a fragile cutaneous landscape that is prone to skin disease due to many factors. Amputations damage cutaneous, nervous, musculoskeletal, and vascular structures, and alter lymphatic drainage. This altered skin, when placed in the socket of a prosthesis, must adapt to a humid environment and withstand the compressive and frictional forces for which it is poorly adapted. These factors and any history of vascular disease, diabetes, or malignancy make stump skin more vulnerable to immunologic and tissue breakdown, leading to an area of local immune dysregulation called an immunocompromised district. This term encompasses the idea that stump skin is more prone to dermatologic conditions, such as inflammation, infection, and malignancies. Unlike the volar skin found on the palms and soles, the stump skin is not adapted to withstand the compressive forces generated from the prosthesis during movement, particularly during ambulation. In some cases, skin disease and pain at the stump lead to prosthesis abandonment, which has a negative impact on amputees' quality of life. Researchers are looking into ways to increase the adaptation and durability of stump skin, thereby decreasing skin breakdown, infections, tumors, and malignancies commonly seen on this vulnerable site. Skin disease continues to be a vexing problem for amputees and those who care for them. This contribution reviews skin disease at the stump site and explores the broader context of the amputee stump as an immunocompromised district.
截肢者的残肢部位呈现出脆弱的皮肤状况，由于多种因素，该部位容易患上皮肤病。截肢会损伤皮肤、神经、肌肉骨骼和血管结构，并改变淋巴引流。这种改变后的皮肤，当置于假肢承窝中时，必须适应潮湿的环境，并承受其难以适应的压力和摩擦力。这些因素以及任何血管疾病、糖尿病或恶性肿瘤病史，都会使残肢皮肤更容易出现免疫和组织损伤，从而导致一个局部免疫失调区域，即免疫受损区。这个术语包含了残肢皮肤更容易出现皮肤病，如炎症、感染和恶性肿瘤的观点。与手掌和脚底的掌侧皮肤不同，残肢皮肤无法承受运动过程中，尤其是行走过程中假肢产生的压力。在某些情况下，残肢部位的皮肤病和疼痛会导致放弃使用假肢，这对截肢者的生活质量产生负面影响。研究人员正在研究如何提高残肢皮肤的适应性和耐用性，从而减少在这个脆弱部位常见的皮肤损伤、感染、肿瘤和恶性肿瘤。皮肤病仍然是截肢者及其护理人员面临的一个棘手问题。本文献综述了残肢部位的皮肤病，并探讨了将截肢者残肢视为免疫受损区的更广泛背景。
