oandp.com

Dear List,

Thank you for prompt responses to my question on best practices to manage
reoccurring epidermoid cysts on an active transtibial. Responses are
summarized below and also summarized in an attached Word Doc.

1)Our docs often prescribe a topical anti-biotic ointment (it
is Clindamycin or benzoyl peroxide), and sometimes an oral anti-biotic I
believe. Surgery a last resort, but cleanliness is a must both on skin
and liner of course, but drill the message into him. Friction and tight
AP's can exacerbate the problem.


2)These cysts usually result from overloading soft tissue due to
incorrect fit or limb volume changes.I would suggest you recast..If
you recast consider using the three stage casting method using
splints and avoiding "global reduction" methods.


3)If careful hygiene (daily wahsing) won't clear it up, go back to a
Pe-lite liner. Not everyone can wear gel liners - particularly active
patients and kids.


4)Could your client have contact dermititis?


5)Almost all of these occurrences that I have encountered are pressure
related, not unlike a lot of Baker's cysts that occur with more active BK
patients, and the locations you are describing are two of the three most
common that I have seen. These usually do not present with other evidences
of skin pressure, If they are recurring, particularly with an active
patient, the only thing I have found to be reliably successful is to
relieve the pressure, which sometimes necessitates a socket design change.
A times I have to change a patient to a focal-weight-bearing socket design
to prevent recurrence. If he has otherwise been successful with his TSB
design, then it may be possible to modify the shape only in the areas of
trouble, although that will necessarily alter the fit and weight
distribution elsewhere. Changing the socket design does not necessarily
mean changing the suspension system, if that has otherwise been successful.
I have never had an isolated case of this that was suspension related.
For evaluation I have also used Silipos Body Discs inside the liner in the
areas of trouble, sometimes solid, other times in a donut shape, to try and
determine how much pressure relief was needed.


6) Often I find that they are regularly shaving the hair on their residual
limb. It seems to be more prominent with patients wearing some type of gel
liner where air exposure is minimal during the day. Proper hygiene is a
must. Stop shaving residual limb and give opportunities for residual limb
skin to stay dry.


7)The way for the patient to deal with the situation is to keep the limb as
bacteria free as possible. Sunlight is a good way to do this. expose the
residual lmb to sunlight for about 15 min. per day usually does the
trick. Healing up the affected area an be done with rubbing alcohol.


8)I have a patient that was having the same issues and a vacuum suspension
system reduced their frequency quite a bit.


9)This is an age old complication, I have over thirty five years
experience, what I have found is you need to accommodate the cyst regions
but you must also increase pressure adjacently.


--
*Duane Nelson C.P(c)*
Saskatchewan Abilities Council
2310 Louise Ave.
Saskatoon, SK
S7J 2C7
306-374-4400