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VOLUME 1, ISSUE 2, 2018; ABSTRACT, POSTER PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: 
https://doi.org/10.33137/cpoj.v1i2.32016                                                               

 

1 

 
OPEN  ACCESS 

 

AOPA’S 101 ST NATIONAL ASSEMBLY ABSTRACTS, SEPTEMBER 26-29, VANCOUVER, CANADA, 2018 
 

ABSTRACT (POSTER PRESENTATION) 

INHIBITING PSEUDOMONAS AERUGINOSA GROWTH ASSOCIATED WITH 

PROSTHETIC LINERS 

John D. Jarrell*1,2,3,4,5, Dioscaris R. Garcia1,2,5 , Christopher T. Born,1,2,4,5 

1Alpert Medical School at Brown University, Rhode Island, USA. 
2RI Hospital, USA. 
3Materials Science Associates, USA. 
4BioIntraface, USA. 
5BI Medical LLC, USA. 

*Email: johnjarrell@materialsscience.org 

DOI: https://doi.org/10.33137/cpoj.v1i2.32016  

 

INTRODUCTION 

The conventional use of a prosthetic device by amputees 

involves contact of the residual limb tissue with the 

prosthetic socket using an intermediate elastomer liner. 

Roll-on gel liners are applied directly to the limb, and 

slide into the rigid hard socket; the gels are generally 

silicone or plastic. Regardless of the material, or the liner 

system used on a residual limb, problems occur because 

of direct skin and socket or liner contact1. The skin tissue 

of the residual limb is subject to compressive, shear, and 

tensile forces through weight bearing against the 

interface wall. In addition the skin is subject to 

heat/sweat issues that may be seasonal and related to the 

insulation properties of the interface material. A common 

problem encountered by the prosthetic user is socket 

odor, or odor emanating from socket liners2. Proper 

hygiene does not guarantee the reduction of strong socket 

or liner odor over time. In addition, skin problems among 

amputees include rashes, blistering, mold/fungal 

infections and other skin irritations. The socket/wall 

interface (regardless of material composition) is subject 

to local skin sloughing, sweat, and skin oils in a 

warm/moist dark environment over hours of use 

providing an ideal environment for fungal and bacterial 

growth3. To address this problem, our team evaluated a 

titanium and silicone hybrid cleaning and coating 

technology containing a silver fatty acid complex against 

the odor producing, Gram-negative, facultative 

anaerobe, Pseudomonas aeruginosa4.  

METHODS 

The Kirby Bauer assay using Pseudomonas aeruginosa 

was performed to test for the antimicrobial properties of 

standard prosthetic liner compared to liners cleaned and 

coated with a  titanium - silicone forming solutions dope 

with various levels of a silver-fatty acid complex 

(Apocrine™, BI Medical, Coventry, RI). 

A lawn of bacteria was inoculated over tryptic soy agar. 

Circular plugs were punched out of various liner 

materials and placed with the gel side in contact with the 

agar. Coated and non-coated samples were used with 

100% silver controls. The plate was incubated for 48 

hours at 37oC and the assay was recorded every 24 hours 

via photography to measure the zone of bacterial growth 

inhibition.  

RESULTS 

 No inhibition of bacteria was seen with uncoated liners 

against Pseudomonas aeruginosa in a Kirby Bauer assay. 

The zone of inhibition increased with increasing levels of 

silver complex. Interestingly, the uncoated hybrid liner 

material showed an increased halo of bacterial growth 

associated with the residual lubricant. This phenomenon 

was also observed in silicone liner materials, but was 

inhibited by the cleaning and coating process. 

CONCLUSION 

 During the testing of various liner materials cleaned and 

coated with a silver complex doped titanium and silicone 

hybrid in a Kirby Bauer bacterial-inhibition assay versus 

Pseudomonas aeruginosa, it was evident that the control 

(uncoated) materials of hybrid and silicone composition 

were surrounded by a very dense concentration of 

bacteria. This phenomenon was evident after 24 hours of 

incubation at 37oC, but was very noticeable after 48hrs 

incubation even with the almost colorless properties 

displayed by P. aeruginosa in this assay. No other 

material tested displayed this phenomenon for the 

duration of the study. This observation suggests the 

possibility  of  a  lubricating  agent   leaking  out  of  the  

 

silicone and hybrid liner materials, which act as a chemo-

attractant for the bacteria. In essence, these results 

displayed the complete opposite effect from the treated 

mailto:*Email:%20johnjarrell@materialsscience.org
https://doi.org/10.33137/cpoj.v1i2.32016


 

 

 Jarrell J.D, Garcia D.R, Born C.T. INHIBITING PSEUDOMONAS AERUGINOSA GROWTH ASSOCIATED WITH PROSTHETIC LINERS. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, 
VOLUME 1, ISSUE 2, 2018; ABSTRACT, POSTER PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: 
https://doi.org/10.33137/cpoj.v1i2.32016                                                               

 

2 

 
OPEN  ACCESS 

 

AOPA’S 101 ST NATIONAL ASSEMBLY ABSTRACTS, SEPTEMBER 26-29, VANCOUVER, CANADA, 2018 
 

ABSTRACT (POSTER PRESENTATION) 

materials, which showed a halo of bacterial inhibition 

surrounding their surface.  

SIGNIFICANCE 

 The result of increased bacterial growth around the 

uncoated liner material is of particular importance due to 

the potential impact that the phenomenon could have 

with the stump-liner interface. If the liner is releasing a 

bacterial chemo-attractant, it could paradoxically 

potentiate an already favorable microenvironment to 

bacterial and fungal growth within the stump-liner 

interface. These findings may help explain prosthetic 

liner odor and stump irritation/infection even in the 

presence of good hygiene. Effective cleaning and coating 

of prosthetic liners with liquid titanium-silicone-silver 

complexes is an available approach to reducing the odor 

associated with liner use.  

REFERENCES 

1. Levy SW. Skin problems of the leg amputee. Prosthet 

Orthot Int. 1980;4:37-44. DOI:10.3109/03093648009103113 

2. Koc E, Tunca M, Akar A, Erbil AH, Demiralp B, Arca E. 

Skin problems in amputees: a descriptive study. Int. J. 

Dermatol. 2008;47:463-6. DOI: 10.1111/j.1365-

4632.2008.03604.x 

3. Köhler P, Lindh L, Bjorklind A. Bacteria on stumps of 

amputees and the effect of antiseptics. Prosthet Orthot Int. 

1989;13:149-51. DOI:10.3109/03093648909079424 

4. Jarrell JD, Dolly B, Morgan JR. Rapid screening, in vitro 

study of metal oxide and polymer hybrids as delivery coatings 

for improved soft-tissue integration of implants. J BIOMED 

MATER RES Part A. 2010;92:1094-104. 

DOI:10.1002/jbm.a.32435 

DISCLOSURE 

Authors have a financial interest and are consultants for BI 

Medical. 1st and 3rd authors have a financial interest and consult 

for BioIntraface, Inc. 

 

 

https://doi.org/10.3109/03093648009103113
https://doi.org/10.1111/j.1365-4632.2008.03604.x
https://doi.org/10.1111/j.1365-4632.2008.03604.x
https://doi.org/10.3109/03093648909079424
https://doi.org/10.1002/jbm.a.32435

