ORIGINAL POST:
I am in the process of fitting a very short transfemoral amputee, who
has an invaginated scar positioned vertically from the distal end to
almost ASIS. I would like to utilize a silicone liner, however
attempts with several designs failed due to seepage of air through the
scar area and loss of suspension. I believe there was a special gel on
the market that one would apply (like putty) into the invaginated scar
and then don the liner. Has any one tried this product? What are the
results? Who distributes it? Any other ideas like custom liners? I
don’t think they will work for AK-s as the tissues get compressed
within a liner and shape of the scar changes. I will appreciate your
input.
RESPONSES:
I had a similar situation with a short Trans-Femoral amputee (the
scars/invaginations were isolated to the distal end). I had Otto Bock
fabricate a custom ‘end cap’ to create a smooth surface over which an
Alpha liner could be rolled on. It worked pretty well. To cast, I had
the patient lay on their back and extend the limb straight up. I
sprayed the limb with Pam, applied alignate in the scar, and wrapped
this with plaster. I then poured the mold and sent the positive to Otto
Bock in Canada. The local US office should have info. If you have
questions, the staff at the Custom Silicone Products division is VERY
helpful.
Todd Sleeman, CP
I have just made a similar AK socket with the ALPs thermoliner, I heat
moulded the liner to a detailed cast and then draped with plastic. It
looks good, very detailed and is low cost, but unfortunately I haven’t
tried it on the patient yet, but will look forward to the responses
you get, and let you know if it’s successful. BTW I’m not even trying
to use it for suspension – the patient has a silesian belt, it’s
purely for comfort.
V Jarvis CPO
Try evolution liners call 888 818 6777
Our team has just fit short fleshy AK secondary to necrotizing fascitis,
with 4 areas of skin grafting and invaginated distal medial/lateral
scar, with gel strips (Sica Care Gel wound management product by Smith
and Nephew)over most fragile skin, covered with silicone end cup to
provide the distal end with some consistent shape, over which goes the
seal-in silicone liner. Suspension is augmented with modified silisian
belt. So far the suction suspension ‘just rocks’- patient had come off
of alpha max gel liner (with gel strips inside over fragile skin) and
pin suspension augmented with modified silesian belt. Patient uses 3R80
rotatory hydraullic knee. Patient loves the improved control.
What happens to the scar when a liner is placed over – do the edges
approximate together or are they spread apart. If the the invagination
is wider than it is vertical it could be filled in with the use of Sica
Care product because it can be cut to shape the area to be filled.
Linda McLaren, BSR (PT)
Clinical Resource Physiotherapist – Amputation
GF Strong Rehab Centre
4255 Laurel Street
Vancouver, B.C. V5Z 2G9
An evaluation by a good plastic surgeon would be my first choice. I
have had 2 successful cases treated by plastic surgery. They can
eliminate most of the invagination, then do a custom liner if there is
still some invagination left.
Alimed has Pediplast and long term durability is always an issue.
Smith-Nephew Rolyan used to have a variety of 2 component silicone
gels and durability was also an issue.
John Lang
Fillauer makes a silicone fitting gel that works pretty well for
applications like what you are describing. The only draw back, in my
experience, is the silicone can disperse after a while and become
some what nasty after a few weeks of use. FYI, OWW has come up with a
custom alpha liner for situations like what you are describing. I
believe they only have custom liners in the transtibial selections
currently, but it would probably be worth a call to see what they
could do for you. Their number is 1-800-848-4930.
Good luck
J. Robert Pinskton, CPO/L
Call Silipos.
It works great- I believe Fillaeur sells it- Its a silicone putty as
you described. You can mold it into the invagination and then roll
the liner over it. It is reusable- the patient just needs to wash it
out each night when they are washing the liner. Its really quite
simple. You could also have a custom silicone piece made to go in the
liner- there are a couple of very skilled labs that could easily do it
for you- email me and I will forward the info to you- but the putty
works well.
Good luck on tackling this tough fitting problem. If you take an
alginate impression of the residual TF limb, you should be able to
delineate the scar depression accurately enough for TEC to make a
custom liner that will maintain the needed air seal better than a
sized liner. I’d call them to get their thoughts on the feasibility
of this approach. Another approach would be to use the Alpha gel pads
from OWW to just fill in at the proximal edge of their liner directly
over the scar to try and effect a seal there rather than over the
entire length of the scar. I would suggest using auxiliary suspension
such as a silesian belt, TES neoprene suspension sleeve/belt or the
Knit Rite mesh type Power Belt as you will probably lose suction when
your patient sits down no matter how successful you are when he/she is
standing and walking. Hope this helps.
Sincerely,
Ron LeFors, C.P.O.
Fillauer makes a silicone fitting gel that might work for this application.
You could also use a latex suspension sleeve to seal the proximal edge
between the liner and skin?
Markus Saufferer, C.P.
I recently posted a response to an individual looking to fit a
challenging limb with a custom liner. I have attached it for your
review.
One option to consider is the Evolution SP Liner. Invented by Stan
Patterson, CP, of Orlando, Florida, the Evolution SP Liner is durable,
comfortable and is fit as a custom cushion or pin liner. Stan, with more
than 14 years of patient care experience, noticed a void in the liner
market, and wanted a custom liner with the flow characteristics of
urethane and the durability of silicone to provide the optimal interface
for his patients. Made of a platinum-cured silicone, the Evolution SP
Liner is custom made from a mold of each patient’s residual limb. This
custom liner assures that the patient is receiving a socket interface
that is anatomically shaped to fit each patient’s limb and provides
uniformly distributed forces to the tissues. The liner can also be
created with an external shape that is customized as well, such as
needed for stove pipe designed symes or KD sockets. Additionally, the
clinician will feel confident that he/she has provided the patient with
a skin interface that is biocompatible, durable and will remain
virtually odor free.
What I did not state in this response is that the inside of the liner
can accommodate for invaginated scars as well. However, in your
situation it may be challenging to capture the invagination. Typically
it is best to utilize an algination of the residual limb. However, due
to the amputation level this may be challenging but not necessarily
impossible. Once you do have the alginate impression pour it with
plaster and let it set. Once the plaster has set pull a check socket
over top of the plaster model and bi-valve the check socket to
facilitate removal. Mark on the check socket where you would like to
see your liner’s trim lines and send the check socket to Evolution Liner
in Orlando for fabrication. (by mailing a check socket and not the
plaster impression you will save shipping costs.) If you have any
further questions of need clarification please feel free to contact me.
Additionally, the silicone putty you referenced is made by Fillauer.
Kurt Collier, CP
Freedom Innovations
301.695.1113
I don’t know about the putty but you can get a custom tec liner that will
fill in the void. There may be other custom liners that would work as well.
Alpha has some customization available but I don’t know much about it. You
will probably want to go with auxiliary suspension anyway for added
security.
Just my 2 $ ( inflation)… Matt Bailey, LPO
I believe OWW has the putty like Gel. I had tried it when I first
learned of its availablity but the application was on a distal
invagination on a flessy BK. I’m not sure how it would work in your
application.
Raymond Marx, CPO, FAAOP
—
The content of this communication is for exclusive use of the
addressee and may contain confidential, privileged and non-disclosable
information. If the recipient of this communication is not the
addressee, such recipient is strictly prohibited from printing,
photocopying, saving on any media, distributing or otherwise using the
information contained herein. If you received this communication in
error, please contact the sender by e-mail, fax or telephone and
destroy this document.
Stephan R. Manucharian, CP
Orthopedic Arts
Brooklyn, NY 11201
718-858-2400; Fax: 718-858-9258;
[email protected]
