Innovative Use of Thighplasty to Improve Prosthesis Fit and Function in a Transfemoral Amputee

Background: Excess residual limb fat is a common problem that can impair prosthesis control and negatively impact gait. In the general population, thighplasty and liposuction are commonly performed for cosmetic reasons but not specifically to improve function in amputees. The objective of this study was to determine if these procedures could enhance prosthesis fit and function in an overweight above-knee amputee. Methods: We evaluated the use of these techniques on a 50-year-old transfemoral amputee who was overweight. The patient underwent presurgical imaging and tests to measure her residual limb tissue distribution, socket-limb interface stiffness, residual femur orientation, lower-extremity function, and prosthesis satisfaction. A medial thighplasty procedure with circumferential liposuction was performed, during which 2,812 g (6.2 lbs.) of subcutaneous fat and skin was removed from her residual limb. Imaging was repeated 5 months postsurgery; functional assessments were repeated 9 months postsurgery. Results: The patient demonstrated notable improvements in socket fit and in performing most functional and walking tests. Her comfortable walking speed increased 13.3%, and her scores for the Sit-to-Stand and Four Square Step tests improved over 20%. Femur alignment in her socket changed from 8.13 to 4.14 degrees, and analysis showed a marked increase in the socket-limb interface stiffness. Conclusions: This study demonstrates the potential of using a routine plastic surgery procedure to modify the intrinsic properties of the limb and to improve functional outcomes in overweight or obese transfemoral amputees. This technique is a potentially attractive option compared with multiple reiterations of sockets, which can be time-consuming and costly. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Published online 12 January 2018. Received for publication June 12, 2017; accepted November 15, 2017. A part of this research was presented at the First International Symposium on Innovations in Amputation Surgery and Prosthetic Technologies, May 12–13, 2016, Chicago, Ill. Supported by numerous philanthropic grants awarded to the Center for Bionic Medicine, primarily those from the George Link, Jr. Foundation and the RIC Women's Board. Disclosure:The authors have no financial interest to ­declare in relation to the content of this article. The Article Processing Charge was paid for by the authors. The research protocol for this study was approved by the Northwestern University Institutional Review Board (STU00090292). Further documentation supporting our informed consent procedures can be provided upon request. Clinical Trial registration number/identifier: ClinicalTrials.gov Identifier NCT02346019. Registered January 9, 2015. Supplemental digital content is available for this article. Clickable URL citations appear in the text. Todd Kuiken, MD, PhD, Center for Bionic Medicine Shirley Ryan AbilityLab, 355 East Erie, Floor 11, Room 1414, Chicago, IL 60611 312-238-2080, E-mail: tkuiken@sralab.org Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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