Amputee skin condition: occlusion, stratum corneum hydration and free amino acid levels
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Patients with a prosthetic limb report negative skin effects, including irritation, rash and chaffing, which can lead to infection, discomfort and reduced wear time to significantly impact normal activities. The aims were to examine the epidermal integrity (transepidermal water loss, TEWL), stratum corneum (SC) hydration [moisture accumulation rate (MAT)], friction and biomechanical properties in active below the knee amputees and to determine the effects of an inert sock liner on skin condition. The liner reduced hydration, TEWL and friction and increased elasticity versus the amputee’s conventional skin care methods. Residual limb TEWL was increased and MAT was reduced versus the contralateral normal skin. In a second study, we hypothesized that complete occlusion would decrease free amino acids (FAA) and quantified them by high performance liquid chromatography in an adult volar forearm model. Occlusion with a water vapor impermeable wet dressing led to increased TEWL, erythema and dryness and reduced MAT versus normal skin, comparable to the results in the amputees. The FAA levels were significantly reduced for the occluded sites. The results suggest that residual limb occlusion in amputees may block the formation of FAA in the upper SC. Therapies based on replacement of water binding FAAs, may alleviate the consequences of long-term occlusion.
KeywordsStratum corneum Amputee skin Amputee dermatitis TEWL Moisture accumulation rate Free amino acids Skin occlusion Skin hydration Skin barrier compromise
The authors wish to thank Karen Munson, Diane Bare, and Cindy L. Lamerson, MD, for their technical expertise in conducting the skin assessments. The work was supported by a grant from W.L. Gore & Associates, Inc., a graduate student fellowship (Marisa Robinson) from the Society of Cosmetic Chemists and The Skin Sciences Institute of Cincinnati Children’s Hospital Medical Center.
Conflict of interest
The authors declare that they have no conflict of interest.
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