Development of an alternative design for an interscapulothoracic-level cosmetic shoulder restoration

Abstract

Introduction: The patient in this case is a 63-year-old female who underwent a right interscapulothoracic-level amputation secondary to infection 6 months before our initial evaluation. She presented with localized lymphedema, scarring, neuromas, and a painful area around the cut end of her clavicle. She was prescribed with a cosmetic shoulder cap prosthesis with the potential for future use of a hybrid or oppositional prosthesis. The patient was very concerned about the appearance of her amputation under her clothing, prioritizing comfort and ease of wear. Materials and Methods: On the first fitting, the first design we tried was a traditional lined socket with a lightweight foam shoulder restoration suspended by a chest harness. After wearing the prosthesis, the patient reported rubbing in her sensitive clavicular area, excessive shifting of the prosthesis on her torso while sitting, as well as visibility through the neckline of her clothes. On the second fitting, we fit the patient with a Compliant Force Distribution (Martin Bionics Innovations, Oklahoma City, OK) frame for suspension of the restoration. The patient continued to experience shifting and discomfort and requested an alternative, which did not use rigid materials. With regards to the definitive design, for our alternative design, we created a design for a highly compliant and breathable garment that would contain a custom removable foam cosmetic shoulder cap, which was mirrored via CAD from the patient's contralateral side. The garments are completely seamless, are full length for easy donning/doffing, and feature an easy snap-in pouch for the shoulder and an incorporated adjustable elastic bust band to control compression. Conclusions: The outcome of the alternative design was successful with the patient reporting wearing the garment/prosthesis at work and when she leaves her home. As a result of the success, the patient became more optimistic and receptive to the idea of exploring the use a full prosthetic system as she continues in her recovery.