Abstract
BackgroundThe soft tissue of the residual limb in transtibial prosthetic users encounters unique biomechanical challenges. Although not intended to tolerate high loads and deformation, it becomes a weight-bearing structure within the residuum-prosthesis-complex. Consequently, deep soft tissue layers may be damaged, resulting in Deep Tissue Injury (DTI). Whilst considerable effort has gone into DTI research on immobilised individuals, only little is known about the aetiology and population-specific risk factors in amputees. This scoping review maps out and critically appraises existing research on DTI in lower-limb prosthetic users according to (1) the population-specific aetiology, (2) risk factors, and (3) methodologies to investigate both.ResultsA systematic search within the databases Pubmed, Ovid Excerpta Medica, and Scopus identified 16 English-language studies. The results indicate that prosthetic users may be at risk for DTI during various loading scenarios. This is influenced by individual surgical, morphological, and physiological determinants, as well as the choice of prosthetic componentry. However, methodological limitations, high inter-patient variability, and small sample sizes complicate the interpretation of outcome measures. Additionally, fundamental research on cell and tissue reactions to dynamic loading and on prosthesis-induced alterations of the vascular and lymphatic supply is missing.ConclusionWe therefore recommend increased interdisciplinary research endeavours with a focus on prosthesis-related experimental design to widen our understanding of DTI. The results have the potential to initiate much-needed clinical advances in surgical and prosthetic practice and inform future pressure ulcer classifications and guidelines.
Highlights
The soft tissue of the residual limb in transtibial prosthetic users encounters unique biomechanical challenges
An example for ongoing controversies is the recent addition of Deep Tissue Injuries (DTI) to the established pressure ulcer staging system of the National Pressure Ulcer Advisory Panel (NPUAP) [1]
An additional 5 articles were identified through references and forward-citation of these sources, amounting to 16 studies in total (Fig. 1)
Summary
The soft tissue of the residual limb in transtibial prosthetic users encounters unique biomechanical challenges. Pressure injuries frequently affect individuals in hospitals, homes, and care settings They are defined as “localised damage to the skin and underlying soft tissue”, and are caused by “intense and/or prolonged pressure or pressure in combination with shear” [1]. An example for ongoing controversies is the recent addition of Deep Tissue Injuries (DTI) to the established pressure ulcer staging system of the National Pressure Ulcer Advisory Panel (NPUAP) [1]. It has long been the prevailing opinion that pressure injuries originate at superficial layers and may evolve into deeper tissues [4]. This type of injury is classified as DTI
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