Bioengineering Science Research Group, Faculty of Engineering and Physical Sciences, University of Southampton, Highfield Campus, University Rd, Southampton SO17 1BJ, UK.
Skin Health Research Group, Faculty of Environmental and Life Sciences, University of Southampton, UK.
Med Eng Phys. 2020 Apr;78:39-47. doi: 10.1016/j.medengphy.2020.01.011. Epub 2020 Feb 5.
In the early stages of rehabilitation after primary amputation, residual limb soft tissues have not been mechanically conditioned to support load and are vulnerable to damage from prosthetic use. There is limited quantitative knowledge of skin and soft tissue response to prosthetic loading.
An in-vivo protocol was developed to establish suitable measures to assess tissue tolerance during loading representative of early prosthesis use. Ten participants without amputation one participant with trans-tibial amputation were recruited, and pressure applied to their calf in increments from 20 to 60 mmHg. Measurements were recorded at relevant skin sites including interface pressures, transcutaneous oxygen (TPO) and carbon dioxide (TPCO) tensions and inflammatory biomarkers.
At the maximum cuff pressure, mean interface pressures were between 66 and 74 mmHg, associated with decreased TPO values. On the release of pressure, the ischaemic response was reversed. Significant upregulation (p < 0.05) in inflammatory biomarker IL-1α and its antagonist IL-1RA were observed at all sites immediately following loading.
The protocol was successful in applying representative prosthetic loads to lower limb tissues and monitoring the physiological response, both in terms of tissue ischemia and skin inflammation. Results indicated that the measurement approaches were sensitive to changes in interface conditions, offering a promising approach to monitor tissue status for people with amputation.
在初次截肢后的康复早期，残肢软组织尚未经过机械适应来承重，容易受到假肢使用的损伤。对于皮肤和软组织对假肢负重的反应，我们的了解有限。
我们制定了一项体内方案，以确定合适的措施来评估早期假肢使用中代表性的负重时的组织耐受性。招募了 10 名没有截肢的参与者（1 名接受过胫骨截肢术的参与者），逐步向他们的小腿施加 20 至 60 毫米汞柱的压力。在相关皮肤部位记录测量值，包括界面压力、经皮氧（TPO）和二氧化碳（TPCO）张力以及炎症生物标志物。
在最大袖带压力下，平均界面压力在 66 至 74 毫米汞柱之间，与 TPO 值降低相关。当压力释放时，缺血反应得到逆转。在加载后所有部位都观察到炎症生物标志物 IL-1α及其拮抗剂 IL-1RA 的显著上调（p < 0.05）。
该方案成功地将代表性的假肢负荷应用于下肢组织，并监测生理反应，包括组织缺血和皮肤炎症。结果表明，测量方法对界面条件的变化敏感，为监测截肢患者的组织状况提供了有前途的方法。
