I have been asked many times what I do about the blisters and skin problems that effect most amputees. Just like everyone else, I experience these problems from time to time. I have heard that those of us with suction suspension end up dealing with these issues more often. The techniques I use are a mixture of things I've heard, things I've experimented with and things I have stumbled upon in moments of desperation. I hope you will find this useful.
OK, one of the best ways to fix your skin problem is to avoid getting it in the first place... makes sense right? There are a few things I do regularly to try to limit possible damage to my skin:
1. I don't baby it. I get a bit of sun on it when I can, I towel it roughly, I wear my leg all the time (unless there is an extreme problem).
2. I keep the hair on the leg trimmed extremely short. I use an electric clipper (set on ZERO with no guard) to do this. I DO NOT EVER SHAVE WITH A BLADE - this will lead to ingrown hairs for sure. The point of keeping the hair short is that it improves my fit, improves my suction, and therefore less problems arise. It also helps Tegaderm to adhere A LOT better. Read about Tegaderm below.
3. As soon as I feel any problem arising I use a dab of vaseline on the area until it goes away. Even if the pain/feeling is barely noticeable, I do it anyway - I don't wait for it to get worse before acting.
4. If I am heading out to do something challenging (a run, ride, a flight or whatever) I will put several Tegaderm dressings on key spots to protect the skin. Tegaderm is microscopically thin, sterile, breathes, is waterproof and adheres VERY well and is generally awesome!
Sometimes, there is nothing you can do... you take off your liner and there it is - a blister, or an ingrown hair or whatever. They're irritating and can be extremely painful... for sure. Here's what I do:
- I bathe, dry off, turn on a bright light and get a really good look at the offender. If there is any popping, or plucking or picking that seems prudent I do it... but I don't do it if it will make a situation worse - use your judgement. Also, NEVER pick, pluck, pop anything that you can't see (i.e. it is on the back of your leg...) this is a recipe for disaster, as I have grabbed skin and pulled only to find that it attaches strongly to swaths of healthy skin - ouch!
- I use Cicatrin. This is a prescription powder that speeds healing. It is extremely fine and a tiny amount will do the trick. I put it on every chance I get to heal the problem. Especially good at night.
- During the day I use Tegaderm. You wake up, your leg is sore and you've got to put on your prosthesis - I know, it sucks. Tegaderm will help you get through those first steps with WAY less pain and it will help keep the pain at bay and speed your healing all day long. Here's the recipe: Put a tiny amount of Cicatrin in the wound (wipe away ALL excess from the skin around the 'problem'), put a Tegaderm dressing over the area, put a small amount of vaseline on top of the tegaderm. What this does: 1. Cicatrin dries and helps heal, 2. Tegaderm protects and reduces/eliminates skin tension and pulling, 3. Vaseline prevents the liner from sticking to the Tegaderm and allows it to slide over it - also reduces pulling/tension on the skin surface.
- I re-do this dressing daily or more often if necessary.
- I take it easy... I try to walk gingerly and protect the area as much as I can during the day so it can heal.
- I watch my moods - I can get a bit short and snappy when my leg hurts with every step I take - I try the best I can to limit this.
- I try to be extra nice to my wife - if I end up going a few days legless - I'll need her on my side! (Can you grab me a ____ dear? Thanks!)
- At home I try to leave the leg/liner off as much as possible to speed healing - whenever it is off I have Cicatrin on the opening.
- If the 'problem' is not healing I sometimes try the following: Cut holes in prosthetic socks around the area, wear no pros. socks and use crutches, wear no leg at all and use crutches. I also tend to get in touch with my prosthetist - if something isn't healing properly it could be due to the fit.
SWEAT: Yes, sweat is a definite issue with these silicone liners. I read somewhere that as amputees we sweat more per square inch of skin because we are missing some square inches of skin.... interesting. Anyway, I find that I can exercise at a high intensity under most conditions for nearly an hour before I start to experience 'real' discomfort from sweat in the liner. Before races I wipe Drysol over my skin... this helps a bit. I don't use it often as I worry that it is pretty toxic stuff.
During training I tend to stop running every 45 minutes to do a quick dry-off on my leg and liner. This is ultra-cautious but I really don't want blisters from training. During a race I will only stop if I think it will be worth it to speed me up or if I think I am about to injure my skin.
In long races I stuff a chamois in my race belt and use that for drying my leg... they are light small and very absorbent.
In short, it seems that every major issue I've had with my leg showed up in the skin first - think of it as an early warning indicator. When you take your leg off at the end of the day (or better yet after a long walk) look at the red marks - they tell the story of the pressure spots on your leg. Learn how it looks when all is good and how it looks when your leg hurts...
Hope this was helpful. Now get out there and GO FOR IT!