While prosthetic technology has significantly advanced in the last ten years, the complications associated with the socket skin interface remain the same. Skin is an amazing organ, with its ability to protect, filter, regulate heat, and regenerate; however, its ability to adapt and stay healthy in a prosthetic socket environment is limited. As all amputees know, a prosthesis is especially prone to trapped moisture, friction, suction, uneven loading and stretching all of which leads to skin breakdown. Heat rash, abrasions, chafing, pressure soars, dry skin, blisters, boils, infected hair follicles, or a myriad of other residual limb irritations are caused as a result of this interface, simply because skin is not designed physiologically to withstand the environment inherent in wearing a prosthesis. Adaptskin™ is a skin care product made specifically for protecting the residual limb at the socket skin interface.

When considering a skin care product for an amputee it is vital that three distinct needs are met.

First, allow the skin to naturally hydrate itself. For many years, epidermal water content has been known to be crucial for skin plasticity and wound healing.[1] Moisturization by inhibiting transepidermal water loss by occlusion hydrates the cells in the stratum corneum via water propagation from the deeper epidermal layers.

Second, assist the epidermis in its role as a barrier. A less glamorous role, but equally important, the skin acts as a vast waste disposal system riding the body of many toxic substances. For the amputee, these substances blend with acidic perspiration, rich with bacteria, and are trapped against the skin. This creates a poisonous brew that eats away at the stratum corneum, and breaks down the barrier function of the epidermis. To combat this, a moisturizing regime needs to have high occlusive properties while augmenting the lamellar lipid layers; thereby reinforcing the hydrophobic barrier of the epidermis, and keep the hazardous fluids away.

The third critical factor is to reduce the residual skin friction. Friction and shear loading removes cells prematurely from the stratum corneum severely compromising the epidermis. Typical moisturizers have little effect on the mechanical properties (i.e., distensibility, hysteresis, and elasticity) of the skin.[2] When moisturizers are used to improve skin plasticity it is suggested that lipid-rich formulations be used.[3] Emollients, which are mainly lipids and oils, hydrate and improve the appearance of the skin by contributing to skin softness, enhanced flexibility, and smoothness. The "skin slip" or lubricity of some emollients aids in reducing the friction between the socket and skin. Higher viscosity emollients are especially important for transfemoral or other non-uniform weight bearing sockets.

Typical over the counter moisturizing lotions and creams can not meet the demanding needs of the amputee. The majority are lotions (oil-in-water emulsions) or creams (water-in-oil emulsions), that are easily washed away with perspiration. Others are chemically enhanced and can cause severe allergic reactions or can not be used on ulcerated or compromised skin. Low pH and sensory reactions, e.g., from lactic acid and urea, can cause burning on application and may reduce patient acceptance.

Other over the counter or prescription moisturizers use humectants. These chemicals (e.g. Urea, gelatin, Glycerin, …etc.) are able to attract water from two sources: they enhance water absorption from the dermis into the epidermis, and in humid conditions they also help the stratum corneum to absorb water from the external environment. For the Amputee attraction of moisture is not the problem; typically there is too much moisture. High perspiration sealed in a warm stagnant environment surrounds every amputee's residual limb. A skin care product needs to repel this moisture not attract it.

A few over the counter products are marketed to amputees, but most of them only address limited specific aspects of the amputees needs. The most widely known product is AmpuBalm™, which is similar to other agricultural and or animal fat based products such as Bag Balm™, or Utter Butter™. Each of these consists primarily of mutton tallow, animal fats, and unrefined lanolin. While these products are based upon age old remedies, they possess a number of drawbacks and limitations for the amputee. These include but are limited to: known allergens, unpleasant odor, spoilage, and pesticides.

Silicone oils (eq: Alps) consist of long carbon chain emollients that improve the appearance of the skin by contributing to skin softness, flexibility, and smoothness. The "skin slip" or lubricity of silicone oil aids in reducing friction, but by itself does not penetrate the epidermis and does not hydrate the stratum corneum. This is why it is typically found as an additive to other active ingredients in over the counter moisturizers.

Adaptskin™ blends clinically proven moisturizers and skin healing agents in a unique, non-water based formula that melts on contact, penetrates skin cell layers, and forms a waterproof barrier increasing hydration. In addition, Adaptskin™ reduces friction, and reinforces the skin's own natural defenses providing superior long term protection addressing the demanding needs of persons faced with limb loss. Adaptskin™ is Safe for all skin types, hypoallergenic, and contains no preservatives.

1. Blank IH. Factors which influence the water content of the stratum corneum. J Invest Dermatol 18(6):433-440 (1952 Jun).
2. Jemec GB, Na R. Hydration and plasticity following long-term use of a moisturizer: a single-blind study. Acta Derm Venereol 82(5):322-4 (2002).
3. Jemec GB, Wulf HC. Correlation between the greasiness and the plasticizing effect of moisturizers. Acta Derm Venereol 79(2):115-7 (1999 Mar).