Thursday, May 26, 2022

Re: VASS Results

Jan Stokosa

After reading the responses to this question, I am should like to offer
these comments for our consideration on this issue:
I suggest we look at, and pursue a greater understanding of, the cause
of Residual-Limb volume changes an amputee experiences. In our
responsibility to provide and maintain a comfortable, stable
socket/prosthesis, we have been reacting to this phenomenon in many clinical
ways. I don’t recall any discussion that addresses this condition, other
than it is a “normal” consequence of amputation, and ways in which we could
accommodate the changes.
My experience over the past 30 years indicates fluid volume fluctuation
is, for the most part, a function of amputation surgical technique (In this
discussion, I exclude cases that involve systemic conditions that predispose
a person to such fluctuations).
When amputation must be done, if a biological/physiological surgical
approach is followed (irrespective of cause), coupled with a socket design
that optimizes the functional characteristics of the Residual-Limb, we find
muscle and subcutaneous tissue much less affected by the trauma experienced
following conventional amputation technique, and conventional prosthesis
socket design.
I would like to know others experience with this theory – that volume
fluctuation is due, in-part, to non-functioning muscle and other
unbiological results of amputation technique ( for purposes of this
discussion, I suggest we exclude conditions that, irrespective of surgical
technique would cause volume fluctuations – such as chemotherapy, dialysis,
etc)

—– Original Message —–
From: “Rick Greenwald”
To:
Sent: Tuesday, October 29, 2002 8:14 AM
Subject: Re: [AND-L] VASS Results

> The mixed results of the VASS survey are not surpising….new technology
is
> always difficult. But, volume management continues to be an elusive goal
> and a most sought after prize…We too have worked very hard to come up
with
> a solution…we support TEC’s efforts and the prosthetists and patients
that
> are willing to try innovative solutions…
>
> Rick Greenwald, PhD
> President – Simbex
>
> SIMBEX
> 10 Water Street, Suite 410
> Lebanon, New Hampshire 03766
> 603-448-2367 (P)
> 603-448-0380 (F)
> www.simbex.com
>
> —–Original Message—–
> From: Orthotics and Prosthetics List [mailto:[email protected]]On
> Behalf Of Charles H. Pritham
> Sent: Saturday, October 26, 2002 8:14 PM
> To: [email protected]
> Subject: [OANDP-L] VASS Results
>
>
> Thank you to everybody that took the time to respond to my
inquiry.
> In
> general I think it is fair to say that the results are mixed. For the
> benefit of the curious, I include the gist of the comments below.
>
> C. Pritham
>
> We have tried the Harmony system multiple times with mixed results. The
> concept is great but the product does not work very reliably.
Maintenance,
> continued use of suspension sleeves and weight are the client reported
> problems. I am waiting for the next version before recommending it again.
>
>
> I refuse to use this system since it voids the warranty on the foot.
>
>
> I have tried VASS system on one patient that has been using vacuum
> suspension for the last 6 year. His comments were after couple of month
> “The idée is not too bad but it is too heavy and the suspension doesn’t
> work properly”, and then he went back on his old prosthesis. This is
> also my believe, that it is a good idée but needs to be more developed.
> It could enhance the blood circulation for those patients that have
> problem with that and at the same time be a problem on patients that
> have to deal daily with volume changes. The weight of the device is also a
> problem and the system needs perfect suspension sleeve to work well and I
> find it still difficult to find a sleeve with that requirement… I
believe
> that for a healthy active user the volume will be come more stable in a
> system like this. The system is exciting and interesting and I would
> recommend you to try it just to build your on ideas on it.
> Good luck
> (The gentleman quoted above is Swedish. Before you criticize his English,
> translate his comments into Swedish.)
>
>
> We fit two different amputees with the VASS system. I regret to inform you
> that we were less than pleased with the results. One of the systems
> incorporated joints and thigh lacer so we had this manufactured by TEC.
> Inadequate space was provided between the inner and outer sockets which
> resulted in the suspension sleeve being pinched and torn. TEC was
unwilling
> to correct the problem. We remanufacutured the outer socket (in our
> facility) so the client could use the prosthesis. Unfortunately, the
> maintenance was very high on this device. The locking mechanism had to be
> replaced twice- due to normal wear and tear. The client’s comment: “I like
> it when it works, but it just doesn’t work very often. It is really
heavy”.
> About three months ago, we redid the socket (no charge) and provided him
> with a locking pin (joints and lacer too). His mom cal! led me recently
and
> stated that it was working well.
> The second client also liked the socket initially, but felt that
maintenance
> was too high on it. He went back to his old leg. TEC will try and convince
> you that only “you” are experiencing these problems, but I won’t be
> surprised if you recieve a few negative comments
>
>
> I’ve fitted this system on two bilaterals and two unilaterals. While it
is
> not yet trouble free I am very impressed with the degree of comfort and
> quality of suspension it provides. I’ve been using Dermo cushion liners
and
> a variety of sleeves but so far the Alps EZ sleeve has worked best.
>
>
> I have just received
> my certification in VASS. My experience with the system is therefore
> somewhat limited however, the science is well done. I believe Mr. Casper
is
> really on to something here. I would recommend to all practitioners to
> examine the information and make there own decisions as to the
> appropriateness of this modality for their patients.
>
> It may take some time for the mechanics to be perfected yet again the ISO
> testing protocols used to test Harmony were extreme, three million cycles
> @3/second with three hundred lbs. is impressive.
>
>
> Good, but……….Complex, lots of things to go wrong. The pumps have had
> several failures but TEC stands behind them completely. Many come back
> visits to correct small problems so the patients needs to be willing to
> travel and be able to follow instructions to the letter. I have had good
> results with this system on “problematic” residual limbs. I understand
that
> and L-code for this system in to come very soon.
>
> ********************
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>
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>
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>
> Public commercial postings are forbidden. Responses to inquiries
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>
> ********************
> To unsubscribe, send a message to: [email protected] with
> the words UNSUB OANDP-L in the body of the
> message.
>
> If you have a problem unsubscribing,or have other
> questions, send e-mail to the moderator
> Paul E. Prusakowski,CPO at [email protected]
>
> OANDP-L is a forum for the discussion of topics
> related to Orthotics and Prosthetics.
>
> Public commercial postings are forbidden. Responses to inquiries
> should not be sent to the entire oandp-l list. Professional credentials
> or affilliations should be used in all communications.
>
>

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