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One popular definition of the word prosthetics is "the art and science of developing artificial replacements for body parts." As a transpelvic amputee and prosthesis wearer for nearly 48 years, I've noticed a disturbing trend recently. Somewhere along the line, the art of prosthetics has been lost and overshadowed by the science. In the push for more high-tech components, it is becoming the norm to forego the cosmetic covering.
Historically, major advances in prosthetics have occurred in times of war. The recent conflicts in Iraq and Afghanistan have lead to the creation of microprocessor knees and myoelectric arms in an attempt to improve the function and quality of life for our returning wounded warriors. Many have chosen to flaunt their new limbs as a badge of honor. Cultural attitudes have changed, and the media, in its relentless pursuit of sensationalism, tends to focus on the athletes with Cheetah running legs or folks who've "pimped" their prostheses with wild paint jobs, decals, and decorations. Yes, it's great that we amputees refuse to hide in the shadows and are proud to appear in public as we choose. And that's my point—for those young male (and female) amputees, if this is their choice, go for it. However, as a professional woman, I do not wish to present myself to the world looking like a comic-book action hero.
Of course, function comes first, but there have been numerous studies and articles in the medical literature regarding the importance of body image and self esteem in the rehabilitation process. I like to draw the analogy to breast cancer reconstruction. As an anesthesiologist, I have personally witnessed innumerable breast reconstruction procedures, from simple implants and tissue expanders to massive latissimus dorsi rotator flaps and have marveled over how much time, effort, surgical intervention, expense, pain, and risk that women will endure to restore a more normal appearance. These procedures are totally acceptable and usually covered by insurance. Surely our prosthetic colleagues could offer a little padding or foam to achieve a cosmetic appearance.
Back in 1962, when I received my first carved wooden leg, I cried. It was a crude but serviceable leg. At least an attempt was made to make it look human, and I could go back to school feeling semi-comfortable about my appearance. The covers since then have improved greatly. I am under no delusion that mine looks like a real leg, but a bit of lightweight foam and some padding goes a long way. If I was a teenager again and all that was offered to me was an uncovered pylon, I would be devastated and would probably reject wearing a prosthesis. I've moderated a number of women's issues seminars locally and at Amputee Coalition of America (ACA) meetings, and this issue comes up over and over again—women objecting to the appearance of their prosthesis. I feel sorry for the gals, young or old, who have survived whatever trauma to lose their limb and are now faced with having to go out in public with nothing but a pylon and an athletic shoe attached. This is a fashion disaster. One's personal appearance is a valid issue.
I have, on occasion, gone without a cosmetic cover during the adjustment and alignment phase of fitting. As a transpelvic amputee, I'm dealing with three joints. I can tell you from experience this can be hazardous to your remaining limbs. I get my fingers pinched, it destroys my clothes, leaves dings and dents in my car, and I cannot cross my legs. Sitting level is impossible without my built-up butt and thigh. The only clothing that works is loose, flowing long skirts (a hemi-burqa!). My cover also serves the purpose of protecting my expensive components from the environment.
I consider myself a very well-adjusted amputee, but I do not like having to put up with the stares and stupid comments from strangers in public. It gets old fast.
I don't want to make this a gender issue, for there are many men in professions in which they prefer to present themselves with a more normal appearance. They object to how their pants hang or get caught up in unprotected components. All of my prosthetists have been men and all have gone out of their way to provide me with the best cosmetic covers they could. My current CP freely admits his lack of artistic ability, but he will always arrange for a skilled technician to come in to finish my leg to my satisfaction.
So my plea to the prosthetists and the industry that creates all these wonderful high-tech components is this: Please don't ignore the art of your profession. Give your clients a choice, to cover or not cover. Take the extra time and effort needed to create the prosthesis most acceptable to your clients. I silently thank my prosthetist for restoring me each time I look in the mirror and see my "leg" back.
Christina Skoski, MD, is retired after 30 years of practice as a clinical anesthesiologist. She serves on the Medical Advisory Committee of the Amputee Coalition of America (ACA), where she draws from her experience as a hemipelvectomy amputee. She also hosts the nonprofit website for pelvic-level amputees, www.hphdhelp.org
