A Total Surface-bearing Prosthesis for a Below-the-knee Amputee due to Carcinoma arising from a Burn Scar / The Japanese Journal of Rehabilitation Medicine

ABSTRACT

Severe burn injuries often result in significant long-term physical complications with scarring and contractures, but cancers associated with chronic burn scars are relatively rare. We report a case of a 58-year-old man with skin cancer arising from a healed burn scar. He initially suffered from an extensive fire burn on both lower limbs as a child. The burn scars extended from his upper thighs to his toes bilaterally and caused severe contractures which immobilized the ankles in plantar flexion. Two years ago, he noticed a small ulcerated lesion on the right heel and self-treated it with topical ointments. However, the ulcer increased in size and became malodorous. He presented to a clinic with a large, ulcerated, tumorous lesion, and histology proved it to be squamous cell carcinoma. He subsequently underwent a right below-the-knee amputation, and the previous scars presented on the stump. Thus the patient received a total surface bearing prosthesis with an Icelandic roll-on silicone socket system, which is ideal for patients with extensive scarring at the stump because it may reduce prosthesis-induced stump injuries by evenly distributing the patient's weight in the socket. After he left the hospital, he walked so far with the prosthesis every day that small ulcers often developed at the right popliteal fossa. However, he did not take care to treat these lesions properly, so we had to educate him on how to treat them. Patients such as these will often require education for self-management, family involvement and regular follow-up to monitor scar ulceration and watch out for any malignant transformation.