Determinants of Skin Problems of the Stump in Lower-Limb Amputees

Objective: To identify determinants of skin problems in lower-limb amputees. Design: Survey, using a questionnaire. Setting: Not applicable. Participants: Lower-limb amputees (N=2039) who either obtained their prosthesis through the Orthopedische Instrument Makerij (a group of orthopedic workshops in the Netherlands) or were a member of the (Dutch) National Society of Amputees (Landelijke Vereniging van Geamputeerden) were invited to participate. In total, 872 lower-limb amputees agreed to participate. Intervention: Amputees filled in the questionnaire to assess characteristics of the amputation and prosthesis, level of activity, slump and prosthesis hygiene, and skin problems. Stepwise backward logistic regression was performed to analyze determinants of skin problems. Main Outcome Measure: Skin problems in the month prior to completing the questionnaire. Results: A total of 816 questionnaires were received. Eventually 805 questionnaires were suitable for statistical analysis, Protective determinants were (in order of magnitude of association) older age, male sex, and amputation because of peripheral arterial disease and/or diabetes. Provocative determinants were (in order of magnitude of association) use of antibacterial soap, smoking, and washing the stump 4 times a week or more often. In total, 63% of the participants (95% confidence interval, 60%-67%) reported 1 or more skin problems. Conclusions: The provocative determinants identified in this study-use of antibacterial soap, smoking, and stump washing frequency-have to be studied for their clinical relevance.