Skeletal extension of limb prosthetic attachments–problems in tissue reaction

Abstract

AbstractThe skeletal attachment of a limb prosthesis approaches two specific and separate problems in tissue reaction to prosthetic materials: Skeletal fixation and trancutaneous interface.The skeletal fixation problem must be looked upon as a method to distribute the stress concentration of prosthetic material in such a manner so that living tissue is not embarrassed by prolonged excessive pressures. One must consider the functional mechanical stresses separate from the toxicological reaction of living tissues to prosthetic materials. Our current experience identifies the fact that vitreous carbon is extremely benign from the standpoint of living tissue reaction. Moreover, when placed in the configuration of irregular surfaces, it apparently encourages bone growth contiguous with the material. To this point, however, the reaction of living material to broad surfaces contiguous with vitreous carbon has not placed under concentration of functional stresses. Porous ceramic to this date has not supplied an appropriate answer to this problem.Transcutaneous perforation is available in the clinical sense only when a method can be presented which requires no specific hygiene and dressing. No drainage at all must be the rule at a transcutaneous perforation. Vitreous carbon in our experience so far has made contiguous epithealization feasible down the neck of a skin perforation. Four millimeters, from our experience, seems to be an appropriate location of epithelial downgrowth before transition into non epithealized connective tissue is available. The use of fixation skirts is felt to be necessary to provide stable, transcutaneous perforation.This paper presents evidence of the favorable tissue reaction both from a skeletal and cutaneous standpoint to vitreous carbon materials. A specific design for the successful skeletal fixation limb prosthesis is as yet not currently available and must await further clinical experience with human skin reaction to transcutaneous devices.