The case for lifelike prosthetic cosmetic covers
The cosmetic appearance of a prosthesis can be of huge psychological importance for many people who use them, even increasing prosthetic use as part of their acceptance. It’s important to understand that there are a variety of options available, including lifelike covers.
According to the NHS’s Clinical Commissioning Policy: “NHS England will not routinely fund high-definition silicone covers for prosthetic limbs, high-definition feet and partial hand prostheses for patients with limb loss”. *
So what options are available for patients?
Off-the-shelf options
Cosmetic options that are readily available from the NHS include a simple stocking, for a few pounds, and covers such as Skinergy, costing a few hundred pounds (photo right from Steeper).
This ‘off the shelf’ cover offers a single skin tone, with basic definition of the toes and nails and is available in 19 colour shades.
Prosthetists simply identify the closest match for the patient with this particular cover.
Bespoke silicon 'HD' versions
If a patient’s clinical activity is funded by a litigation claim, typically under the Rehabilitation Code, then they can readily access high-definition silicone cosmetic solutions through their private provider.
The colour matching process with a silicone technician and patient can be a two-hour appointment, as a colour pallet is created to match skin tones, as well as considering freckles, body hair and even tattoos!
These bespoke solutions offer incredibly lifelike appearance and are almost pieces of art (photo right from Dorset Orthopaedic).
Toby Carlsson, Prosthetist at Pace Rehabilitation, explains:
“When we meet someone for the first time in clinic, we always discuss how a person feels about the appearance of a prosthesis. There are many different options, and we can normally accommodate what people wish for. Sometimes it is about restoring a lifelike appearance and sometimes about making the prosthesis look good in its own right. Either way, it is important to make sure appearance does not affect someone’s confidence when using the prosthesis.”
Benefits for patients
The benefits of such provision can stretch beyond the user, as Pace patient Clifton (pictured above right) recounts:
“It was actually my wife who wanted me to have it, as every time she saw my ‘uncovered’ prostheses, it reminded her of my accident. I feel very comfortable wearing it and am often complimented on just how realistic it looks, that is if someone even notices.”
What do the lawyers say?
From a legal perspective, Trevor Sterling (Senior Partner at Moore Barlow), says:
“As a lawyer and a person of colour, I am acutely aware of the potential psychological benefits of users being provided with matching skin tone devices. Whilst it is largely known by personal injury lawyers that the Rehabilitation Code can be utilised for funding for physical, psychological, social and vocational support, the significance of the positive psychological impact of skin matching devices is often under appreciated. Even if the Rehabilitation Code is not used, interim payments can be made to meet reasonable costs and given the psychological benefits afforded by matching skin tone devices, I would regard this as a reasonable expense.
“When considering such devices, it is important that we look at this through the eye of the user and not the eye of the lawyer in terms of psychological benefit, we must always, as lawyers, consider the perspective of a person of colour. It is therefore incredibly important that users are aware of their options and that lawyers are aware of the range of matching skin tone devices and their positive psychological impact.”
Clinical experts agree on patient choice
Ian Talbot, Prosthetist at Pace Rehabilitation, says:
“It can be a very emotional moment when our patients see their lifelike cosmetic cover for the first time. It means a lot to them, and it matters.”
Matthew Hughes, Managing Director and Prosthetist/Orthotist at Dorset Orthopaedic summarises:
“The choice for amputees in terms of how a limb appears has changed over the years and there has become a trend for patients to show off their limbs for what they are which is great.
“However, the critical bit in this is the term ‘choice’ and sometimes talking to patients they want to blend in and not stand out which is when cosmetic coverings come in to their own, allowing amputees to undertake normal activities of daily living without having to cover a limb up or worry about drawing attention to themselves when they just want to go to the pub with friends or be out for the day with family.
Cosmetic prostheses can give patients choice – an all-important factor too many people may overlook or take for granted.”
* The NHS Policy does not apply to silicone partial feet, where the silicone is a functional aspect of the prosthesis. Such devices are funded.