The soft tissue of the residual limb in transtibial prosthetic users encounters unique biomechanical challenges. Although not intended to tolerate high loads and deformation, it becomes a weight-bearing structure within the residuum-prosthesis-complex. Consequently, deep soft tissue layers may be damaged, resulting in Deep Tissue Injury (DTI). Whilst considerable effort has gone into DTI research on immobilised individuals, only little is known about the aetiology and population-specific risk factors in amputees. This scoping review maps out and critically appraises existing research on DTI in lower-limb prosthetic users according to (1) the population-specific aetiology, (2) risk factors, and (3) methodologies to investigate both. A systematic search within the databases Pubmed, Ovid Excerpta Medica, and Scopus identified 16 English-language studies. The results indicate that prosthetic users may be at risk for DTI during various loading scenarios. This is influenced by individual surgical, morphological, and physiological determinants, as well as the choice of prosthetic componentry. However, methodological limitations, high inter-patient variability, and small sample sizes complicate the interpretation of outcome measures. Additionally, fundamental research on cell and tissue reactions to dynamic loading and on prosthesis-induced alterations of the vascular and lymphatic supply is missing. We therefore recommend increased interdisciplinary research endeavours with a focus on prosthesis-related experimental design to widen our understanding of DTI. The results have the potential to initiate much-needed clinical advances in surgical and prosthetic practice and inform future pressure ulcer classifications and guidelines.

中文翻译：

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探索经胫假体在深部组织损伤发展中的作用：范围审查。

经胫骨假肢使用者的残肢软组织遇到了独特的生物力学挑战。虽然不打算承受高负荷和变形，但它成为残渣假体复合体中的承重结构。因此，深部软组织层可能受损，导致深部组织损伤 (DTI)。虽然在 DTI 对固定个体的研究方面做出了相当大的努力，但对截肢者的病因和人群特定风险因素知之甚少。该范围审查根据 (1) 人群特异性病因学、(2) 风险因素和 (3) 调查这两种方法的方法，对现有的下肢假肢使用者 DTI 研究进行了规划和批判性评估。在 Pubmed、Ovid Excerpta Medica、Scopus 确定了 16 项英语研究。结果表明，假肢使用者在各种负载情况下可能面临 DTI 的风险。这受个体手术、形态学和生理学决定因素以及假体组件选择的影响。然而，方法学的局限性、患者间的高变异性和小样本量使结果测量的解释变得复杂。此外，缺乏关于细胞和组织对动态负荷的反应以及假体引起的血管和淋巴供应改变的基础研究。因此，我们建议增加跨学科研究工作，重点关注与假肢相关的实验设计，以扩大我们对 DTI 的理解。