The Amputee Survival Kit
All amputees have a basic dilemma. No matter how well fitting their prosthesis may be, their residual limb doesn’t stay the same. It swells, it shrinks, and it gets pimples, muscle cramps, callouses, blisters, and any other maladies that afflict normal human skin. To compound matters, often times amputees do not even have normal skin; scar tissue, skin grafts, and skin folds can complicate matters. To add insult to injury, this skin is placed in a warm, moist, and dark environment and placed under pressures that it was never designed to withstand. This is the situation for the residual limb.
How do amputees cope with this dilemma? Most of us utilize some type of survival kit. This article will describe some of the amputees have found useful when their residual lim has problems. This information is based on my personal experience as an amputee (22 years) and having been a Certified Prosthetist for fifteen years.
First we must keep the skin clean. Soap and water work great on a daily basis for most of the body. However, you’ve got a part of your body in what is essentially a petridish, growing bacteria. Even if you utilize an antibacterial soap, within a short time most of the bacteria has regrown. Products that kill lots of bacteria are rubbing alcohol, Phisoderm, Hibiclens, and Betadine. These are all over-the-counter cleansers. Alcohol will dry your skin out, so be cautious using it. The other antibacterial soaps kill most of the bacteria yet provide little long lasting antibacterial protection. A former disabled ski team member, named George Lombard, introduced me to Phisohex. It is a prescription item and must be prescribed by your physican. The difference with Phisophex is that it contains hexachlorophene which inhibits the growth of bacteria over a long period of time. This means hours after you have washed you still have a low bacteria count, greatly reducing the possibility of irritation or infection. Any skin rash or itch should be a signal to discontinue use of whatever you utilize to clean your skin. Take particular care to dry out any skin folds, dimples, or any place that can trap moisture.
Skin protection materials is a topic I’ve lectured on for years. When I lost my leg twenty two years ago, the only product available was Ampubalm, a salve with lots of lanolin and mutton tallow (yuk) The stuff smelled awful by did provide some friction relief. Then came Ampaid, which smelled better and had a similar effect as Ampubalm. Bagbalm is a lubricant utilized in the dairy industry (use your imagination) and also provides a friction reduction element that can soothe the skin. One of the most common errors that amputees make on skin care, is the use of bandaids or gauze bandages on abrasions. Often times abrasions are created by excessive pressure on a limited skin surface area. Bandages only increase often times doing more damage than good. Also the adhesive on bandages can damage delicate or healing skin when removed.
Over thirteen years ago, I became acquainted with Second Skin, a Spenco product. This product has become a staple in my amputee’s kit (the stuff I usually carry with me). Second Skin is a thin (1/16 inch) piece of perforated silicone gel. It applies directly to the skin and adheres by its own viscosity. It totally elimates skin friction, allows the skin to breathe, and can actually promote healing. It can be utilized for prevention or if an abrasion or blister appears. It is expensive and can only be used once, but for anyone who has had to endure days of pain because of a simple abrassion, it is worth it.
Second Skin does not work well above knee suction sockets unless held in place with their adhesive strips. There are some products that will work; Bioclusive, Tegaderm, Op-Site, and Acuderm are the ones I am familiar with. These products provide a thin, adherent membrane that prevents friction and allows the skin to breathe. The product can be left on for several days and it is best removed under water. Be careful not to leave it on for too long as it prevents the skin from sloughing off and should be replaced every 2-3 days.
For all amputees who wear some type of sock there is a simple way to make temporary socket adjustments. A small hole cut into the sock will provide temporary relief to skin that has been damaged by either an abrasion or a pimple, especially when there is associated tissue swelling. This works best with a five ply sock, (the thinner the sock, the less relief), and the trick is to cut as small a hole as possible. Use an older sock if you have one, and pull onto your residual limb, take a pencil and draw a circle around the affected area. Remove the sock and cut a hole about half the size of what you drew. When the sock is put back on, the hole generally stretches giving plenty of relief. If not, then carefully open up the hole a little more. Too big of a hole does not provide good relief.
What constitutes a good amputee survival kit? I am a below knee amputee and my kit consists of: Second Skin, a tiny pair of scissors (for cutting holes in socks), Hydrocortisone (will lubricate and kill an itch), duct tape (I have hiked many miles on feet taped together), a foot bolt wrench and any other Allen wrenches that my let utilizes. I also carry a wash cloth or bandana to wipe perspiration off my residual limb and my sleeves. When I am engaged in heavy activities where I perspire a lot, I sometimes have to wipe my suspension sleeve about every half hour. I carry my kit in a fanny pack with a water bottle.
Above knee amputees will use slightly different materials in their kits, depending on whether they utilize suction or a sock. Tegaderm, or one of the other adherent membranes may be substituted for Second Skin. An excellent lubricant for whenyour skin rubs against any surface is Vaseline. Since it does not absorb into the skin, it provides friction relief for hours. Make sure you use it sparingly. For suction socket wearers who will be engaging in activities that could cause a lot of perspiration, I recommend some auxiliary means of suspension. A removable silesion belt is an excellent addition to any above knee suction socket but it needs to be built into the prosthesis. There are neoprene suspension belts that give great freedom of motion that can be obtained through your prosthetist.
Upper extremity amputees rarely experience the friction and pressures of ones body weight on a prosthesis. However, under heavy loading, or over delicate skin, pressure and friction can occur. A kit including scissors, Second Skin, and Vaseline can be of use.
Each amputee will find the specific combination of skin protection materials to create their amputee survival kit tailored for them personally. Residual limbs change under pressure, over time, especially under increased activity. If you an am amputee an dyou don’t have some type of survival kit then it’s like driving around without a spare tire for your car.
The Survival kits you should have, one for home and one for travel. These kits are the same proven ideas that we have found that work, you will find that you will taylor the kit to fit your needs as time goes on.
- 1 small pair of scissors
- Bioclusive, Tegaderm, Op-Site, or Acuderm (for abrasions or blisters, 3-5 units depending on time away)
- Hydrocortisone for itch and lubrication
- Talc, Zeasorb, Baby powder or another sweat absorbent (for help for putting your Prosthesis on)
- A small towel, to Dry your stump for sweat
- If you’re on a trip then I would take Physlohex, Hibiciens, or one of the other strong Antibacterial soaps to keep your stump clean
- Handi wipes, Alcohol preps or something smiliar (to keep the stump well as the socket clean)
- Extra stump socks and sheaths
- A stocking net and valve tool (to help you get your suction socket on after you’ve repaired your body parts or prosthesis)
- A Foot Bolt and wrench plus all of the allen wrenches (for your prosthesis for adjustments and repair)
- Duct tape (for temp repairs, like if your frame, foot, or socket needs temp help – smallest roll you can find)
- Thin cell foam (to help alleviate pressure points on your weights bearing areas)
- Lubriderm or some other Medicated cream (for dryness)
- Stump shrinker (if you have to take it off to repair then you want to be able to get it back on)
- Topical antibiotic (for minor sores or popped pimples then cover them with Tegaderm)
- 5-10 Pain killers (depending how long you will be away from home)
This is just a basic travel kit you can be as elaborate or delete things that don’t apply to your situation. You should try to get all of your creams, powders, Duct tape, and cleansing agents in the smallest possible sizes so that you can have them with you at all times. It goes without saying that you should carry all of your necessary medications with you when you will be away from home for any period of time.