Sunday, November 27, 2022

BK Scarring: Responses

John Brinkmann

Initial Question

I’m working with a trans-tibial patient s/p failed limb salvage, with severe scarring on the distal end of the residual limb. Grafts are present on the

posterior and distal residual limb. Reducing shear on the grafted tissue is an important goal. What liner would you recommend? Specifically, would you use a

liner that adheres to the skin or one that uses a layer of lubricant between the liner and skin?

Thanks for all the replies. The use of elevated vacuum and liner with lubricant was the most common suggestion.
John Brinkmann, CPO

__________________________________

try a liner sock from knit rite, reduces the stick to skin at the distal half of the limb under the liner.
Christopher J. Phillips, C.P.O.

We have similar lady bilateral Trans tibial 60 yrs old with bony irregular stump with scarry graft capping adherent. We decided Ottobock Dermaseal stump socks
Dr. suhail

This sounds like a good candidate for a custom urethane liner, which is always used with a lubricant. If you choose to use another liner I would still lean toward some type of lubricant.
Eddie V. White, CP
Beacon Prosthetics and Orthotics

I would use an elevated vacuum system and a custom TEC liner. I have had great

success with healing rates under the elevated vacuum. Use of the lotion will

help keep the distal end mobile and enhance the healing rate. Convatec and Adaptskin 50

Good luck!

Jeff Ropp, C.P.

Historically I have used custom TEC liners with suction seal Sleeve and or a valve. Lubricant betweeen the leg and liner. Forget the gel or silicine interfaces.
Ed Gormanson CP

Hi,
I use the “old” fashioned TEC liner with Vaseline, it worked great. Did switch to a alpha custom type and he uses a antibacterial cream that doesn’t seem to bother the gel and keeps a sensitive area from sticking.
Pat

Dear John,

Personally I would use a liner that adheres to the skin to totally eliminate friction, using a very skin-friendly material of course (Original Alpha liner?). Elevated vacuum could further eliminate friction and any unwanted movements between residual limb and socket, although it could also reduce the “cushioning effect” of the gel, but then an electric system like the E-Pulse or LimbLogic allows you to controll that level of vacuum. This is a tough one where some “trial and error” might be dificult to avoid.
Good luck,
Wim Stynen
Prosthetist –
OrtoSolutions / Belo Horizonte, Brazil

John,
Otto Bock custom Urethane uncovered liner, lubricant between skin and liner, sealing sleeve/expulsion valve suspension.
Greg Straub, CPO
Asheville, NC

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