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Establishing a measurement array to assess tissue tolerance during loading representative of prosthetic use

Establishing a measurement array to assess tissue tolerance during loading representative of prosthetic use
Establishing a measurement array to assess tissue tolerance during loading representative of prosthetic use
Background

In the early stages of rehabilitation after primary amputation, residual limb soft tissues have not been mechanically conditioned to support load and are vulnerable to damage from prosthetic use. There is limited quantitative knowledge of skin and soft tissue response to prosthetic loading.

Methods

An in-vivo protocol was developed to establish suitable measures to assess tissue tolerance during loading representative of early prosthesis use. Ten participants without amputation one participant with trans-tibial amputation were recruited, and pressure applied to their calf in increments from 20 to 60 mmHg. Measurements were recorded at relevant skin sites including interface pressures, transcutaneous oxygen (TCPO2) and carbon dioxide (TCPCO2) tensions and inflammatory biomarkers.

Findings

At the maximum cuff pressure, mean interface pressures were between 66 and 74 mmHg, associated with decreased TCPO2 values. On the release of pressure, the ischaemic response was reversed. Significant upregulation (p < 0.05) in inflammatory biomarker IL-1α and its antagonist IL-1RA were observed at all sites immediately following loading.

Interpretation

The protocol was successful in applying representative prosthetic loads to lower limb tissues and monitoring the physiological response, both in terms of tissue ischemia and skin inflammation. Results indicated that the measurement approaches were sensitive to changes in interface conditions, offering a promising approach to monitor tissue status for people with amputation.

1350-4533
Bramley, Jennifer, Louise
102c61c2-fb86-4efb-ae98-053d46207f53
Worsley, Peter
6d33aee3-ef43-468d-aef6-86d190de6756
Bostan, Luciana
9b269056-e210-4ab7-815a-f373528dcd66
Bader, Daniel
9884d4f6-2607-4d48-bf0c-62bdcc0d1dbf
Dickinson, Alexander
10151972-c1b5-4f7d-bc12-6482b5870cad
Bramley, Jennifer, Louise
102c61c2-fb86-4efb-ae98-053d46207f53
Worsley, Peter
6d33aee3-ef43-468d-aef6-86d190de6756
Bostan, Luciana
9b269056-e210-4ab7-815a-f373528dcd66
Bader, Daniel
9884d4f6-2607-4d48-bf0c-62bdcc0d1dbf
Dickinson, Alexander
10151972-c1b5-4f7d-bc12-6482b5870cad

Bramley, Jennifer, Louise, Worsley, Peter, Bostan, Luciana, Bader, Daniel and Dickinson, Alexander (2020) Establishing a measurement array to assess tissue tolerance during loading representative of prosthetic use. Medical Engineering & Physics. (doi:10.1016/j.medengphy.2020.01.011).

Record type: Article

Abstract

Background

In the early stages of rehabilitation after primary amputation, residual limb soft tissues have not been mechanically conditioned to support load and are vulnerable to damage from prosthetic use. There is limited quantitative knowledge of skin and soft tissue response to prosthetic loading.

Methods

An in-vivo protocol was developed to establish suitable measures to assess tissue tolerance during loading representative of early prosthesis use. Ten participants without amputation one participant with trans-tibial amputation were recruited, and pressure applied to their calf in increments from 20 to 60 mmHg. Measurements were recorded at relevant skin sites including interface pressures, transcutaneous oxygen (TCPO2) and carbon dioxide (TCPCO2) tensions and inflammatory biomarkers.

Findings

At the maximum cuff pressure, mean interface pressures were between 66 and 74 mmHg, associated with decreased TCPO2 values. On the release of pressure, the ischaemic response was reversed. Significant upregulation (p < 0.05) in inflammatory biomarker IL-1α and its antagonist IL-1RA were observed at all sites immediately following loading.

Interpretation

The protocol was successful in applying representative prosthetic loads to lower limb tissues and monitoring the physiological response, both in terms of tissue ischemia and skin inflammation. Results indicated that the measurement approaches were sensitive to changes in interface conditions, offering a promising approach to monitor tissue status for people with amputation.

Text
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Restricted to Repository staff only until 5 February 2021.
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More information

Submitted date: 24 August 2019
Accepted/In Press date: 26 January 2020
e-pub ahead of print date: 5 February 2020

Identifiers

Local EPrints ID: 437445
URI: http://eprints.soton.ac.uk/id/eprint/437445
ISSN: 1350-4533
PURE UUID: 435f5575-23a1-4e67-b235-c1ea21eff908
ORCID for Jennifer, Louise Bramley: ORCID iD orcid.org/0000-0003-0414-3984
ORCID for Peter Worsley: ORCID iD orcid.org/0000-0003-0145-5042
ORCID for Luciana Bostan: ORCID iD orcid.org/0000-0003-3882-2619
ORCID for Daniel Bader: ORCID iD orcid.org/0000-0002-1208-3507
ORCID for Alexander Dickinson: ORCID iD orcid.org/0000-0002-9647-1944

Catalogue record

Date deposited: 30 Jan 2020 17:38
Last modified: 07 Mar 2020 01:38

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