Case   Report:
Glidewear Patch on a unilateral left below the knee amputee with ulcer on his distal tibia from shear forces
Charles   Kuffel   CPO,   FAAOP
Kevin   L   Hines   CPO
Patient   Demographics:
Age/sex:   69   yrs/male
Primary   diagnosis:   Left   below   knee   amputee   from   complications   from   type   2   diabetes   and   right   charcot   neuropathy.
Case   Overview:
The   referenced   patient   is   a   unilateral   transtibial   amputee.
He   presents   with   type   II   diabetes   with   complications   resulting   in   his   transtibial   amputation   on   the   left   side   approximately   7   years   ago.
Patient   has   been   a   full   time   prosthetic   user   since   shortly   after   the   amputation   with   a   K3   functional   level.
He   also   wears   depth   inlay   diabetic   shoes   with   custom   diabetic   inserts   on   the   right   lower   extremity   to   provide   total   a   total   contact   protective   environment   for   his   remaining   at ‐ risk   lower   extremity.
Patient   was   fit   with   transtibial   prosthetic   socket   with   gel   locking   liners.
Patient   has   returned   to   normal   activities   of   daily   living   after   fitting   and   break ‐ in   period   in   his   transtibial   prosthesis.
Patient   has   functioned   as   a   full ‐ time   wearer   at   an   upper   K2/lower   K3   functional   level   since   his   amputation.
Patients   only   issue   since   being   fit   was   consistent   skin   breakdown   over   his   distal   tibia   from   pressure   and   shear   forces   between
patients   skin   and   the   gel   locking   liner.
Treatment   Protocol:
Patient’s   socket   has   been   fit   within   the   last   six   months   and   is   total   contact   with   an   additional   soft   pad   placed   in   the   area   of   the   anterior   tibia   due   to   previous   issues   with   distal   tibial   skin   breakdown.
Normal   prosthetic   techniques   such   as   pretibial   pads   and   pads   built   into   the   socket   over   the   area   of   pressure   were   used   to   try   and   address   the   area   of   concern.
Padding   the   socket   and   relieving   the   area   were   helpful,   but   did   not   provide   adequate   relief   from   shear   to   keep   patient   from   having   skin   breakdown.
A   patch   of   a   shear   reducing   material   was   placed   between   patient’s   distal   tibia   and   the   locking   gel   liner.
The   material   was   used   to   spot   reduce   the   shear   forces   over   patients   distal   tibia   that   was   causing   him   to   have   skin   breakdown.
Interface   liners   are   fabricated   in   a   linear   fashion   but   undergo   multiple   plane   disfiguration   during   dynamic   prosthetic   use.
This   pushing   and   pulling   between   the   skin,   liner,   and   socket   can   created   areas   of   shear   leading   to   skin   disruption .
The   use   of   the   patches   has   allowed   patient   to   spot   reduce   shear   over   his   distal   tibia.
Patient   used   the   distal   patches   in   conjunction   with   wound   application   of   Medihoney
dressings   to   speed   the   healing   of   the   wounds.
Patient   healed   his   large   open   area   in   6   weeks   while   continuing   use   of   his   prosthesis   and   has   maintained   healed   status   since   being   fit   with   the   patches.

Ongoing   Management:
Mr.
X   continues   to   function   as   an   upper   K2/   lower   K3   ambulator   wearing   his   prosthesis   12 ‐ 14   hours   a   day   to   maintain   his   activities   of   daily   living.
He   uses   shear   reducing   fabric   over   his   distal   tibia   and   underneath   his   gel   liner   at   all   times   for   shear   reduction.
The   use   of   these   patches   has   allowed   patient   to   function   at   his   highest   possible   level   without   the   incidence   of   reccurring   skin   disruption.
Images:
3/22/2013
3/28/2013
4/23/2013