thanks to all who replied – here are the responses i received
heather davidson
use some sort of lotion around the seal so it doesn’t
stick going down, but not vasoline as I’ve had trouble
with that being too slick to hold.
I have used some seal-inn liners. The only patient that had some problems with was an active male trans-femoral amputee with a very tapered residual limb. He did not experience any problems whilst walking, but felt the prosthesis became undone or lost suction when driving his car (sitting with a sharply bended knee) or when horse riding. After two unsuccessful attempts with the seal inn liner I switched back to the Locking Pin. I have used the seal-inn since, and would personally recommend it to most above-knee amputees. It works wonderfully with the MAS socket design as well.
>From my personal experience with the same problem here are my recommendations:
1) Use a durrplex (or equal) inner liner, similar to the Harmony fabrication recommendations. This provides a very smooth inner surface for the seal to bond with. Make it very thin (so that it doesn’t add much weight) and rough up the outside surface with sandpaper to facilitate the bonding of the lamination to the inner liner.
2) Make sure the socket is tight enough, particularly in the pre-tib and popliteal areas. Any localized looseness will allow the seal to move away from the socket wall. I had problems with the seals releasing until I made the sockets tight enough. Since learning that, I’ve had sockets that maintain suction so well that they are difficult to remove.
Had mixed results with the seal-in on both AK and BK.
The liner needs to be undersized in accordance with Ossur’s guidlines, if in doubt, go for the smaller liner. Also, shorter conical residual limbs have been harder to fit, maybe a distal cup would help. Also had problems losing suction in full knee flexion. The sealing ring also seems to deteriorate over time. I think the concept of the liner is good, it has just been hard to get consistent results. The valve that Ossur sell with the system is not great either.
If you are using a flexible inner socket with a window frame, you will have suction problems if you had a nylon over your positive model when you pulled your flexible plastic. As impossible as it sounds, that tiny little cross-hatching of the nylon WILL impart a grain to the plastic and let in just enough air to ruin the suction seal. You MUST pull your flexible plastic straight against your plaster positive model to get the smooth inner surface. I learned the hard way. Good luck.
just the obvious ones…..if the socket is very contoured the seal could pucker……..if the patient fluctuates in volume………if the socket surface has a weave from the lamination it could leak….and finally is the valve sealing correctly….or finally do you have enough compression at the level of the seal……
If the sealed system is loosing suction due to distal shrinking or
Volume fluctuation, apply the new Silipos distal roll-on onto the patient. Then roll the Seal-in over it. The roll-on is about 2mm thick of 100% medical grade silicone. I have used up to 2 of them overlapping eachother to easily tighten the distal end. Make sure to stagger the edges. This is a very easy way to allow the patient to adjust the tightness themselves. The roll-on needs to be gently pulled up or it will tear. If the seal continues to leak, look at the size of your liner as it may be that the patient shrunk down a size. Used in conjunction with the socks for proximal looseness, this is a
nice option for a little trial and error. I also keep patients in
reinforced check sockets a little longer if I know their volume may change and do a 2nd or 3rd check socket before I finish the socket. Good luck.
I have found that the seal-in workes well for long AKs. I thought it would be an excellent choice for a particular BK. Her residuum is long, slender, and boney with 3 inches of redundant tissue distally. She was not happy with a pin system and did not have room or weight tolerance for a VASS. She loved the seal-in liner, but lost suction during aggressive walking. A clear socket revealed the liner was reflecting back and breaking the seal. The 18 cm liner has such a small circumference and the tugging just broke the seal. The rep told me this has happened before, but does not seem to happen with larger liners. In addition, if you call your rep, they can probably sample a liner to you to try out.
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