 Thank you all, I have past the info along to my patient. Original post was lengthy so in brief: pt has extraordinarily hairy TF residual limb, it historically a heavy sweater & has been having issues with painful scattered white head pimples.
Replies were interesting…Sounds like a tricky sort of residuum. First thoughtswould be;1.     I’ve had good success with clients using the antibacterial types washesgenerally used by teenagers to reduce oil and skin bacteria, sometimescombining this with use of antibacterial hand rub used prior to donning toreduce the level of skin flora to infiltrate the blacked skin pores and thenescalate  into the large pimple. Had not yet combo’d these tactics.2.     I’ve also recently had several clients use IPL to remove hair from theirresiduum. This is very effective with the dark thick hair that it sounds likethis gentleman has. Has massively reduced their sweat/folliculitis problem. pt looking into this!3.     Lastly, sounds like this gentleman might need to consider a revision atsome stage by the sounds of it, that amount of loose tissue is never ideal, butif it’s too long for correct KC height, may be worth the time of a revision,with the added bonus of yourself being able to request specifics of shape,myodesis/myoplasty etc etc.  NOT an option for this guy at this time.Good luck!
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 CPO*******************************We had a patient use Hibiclens pre-surgical scrub for a”pimple” issue with good success. This was used post wear prior togoing to bed at night as a normal hygiene cleansing. Could be used prior todonning as long as it is washed off good per instructions on the bottle.  Not tried yet; good option
Not similar to the type of limb you are describing as he was not particularlyhairy nor trans-femoral. Might be worth a try.Â
Best of luck.***************************Have you tried liner-liner socksunder the liner?  pt tried & did not care for them
Also, I only recommend Dawn dishwashing liquid, as it washes away with no filmleft in the liners. Started using.
Have you tried any other types of liners? Is an option moving fwd. His preparatory stage is nearing an end.
CPOWe like the OWW Alpha Hybrid progressive selectlinershttps://www.willowwoodco.com/products-services/liners/transtibial/alpha-hybrid-liners/.For patients that have skin issues we use the Medi sensitive version.  We do live in Florida, sohot and sweaty are our way of live in the summer. So, we have had good successusing the OWW Alpha Smart Temp liners.  Haveyou considered changing liner type? I haven’t had the chance to try them yetbut Endolite and Uniprox have started to manufacture liners with holes in them:     http://www.uniprox.de/en/products/prosthetics/socket-technologies.htmlhttp://www.endolite.com/products/silcare-breathe-liner Iknow ALPS used to have a liner equiped with a drain valve through theattachment attachment but they’ve stopped making them. However, neither Uniproxnor Endolite talks about where the sweat should go while wearing theprosthesis… Technicienen orthèses/prothèses Endolite’s “Breathable” is only available for transtibial- confirmed again last week. And BOTH Endolite & Uniprox liners are cushion only- no breathable locking liners.
Thanks again!Rick
Rick Milen, L/CPONEXSTEP, Inc.West Lawn, PA
