Wednesday, May 25, 2022

Re: Blisters

The Kogans

Is your patient getting abrasion blisters or water blisters. I have been
working with silicone liners for the past 8 years. I have found that if the
liner is too loose, the patient may develop excessive friction within the
posterior part of the liner against the skin causing friction blisters.
Another cause of friction blisters comes from improper donning of the liner.
The patient will roll the liner on properly until about the knee and then
invert the liner to pull it up like a stump sock. This causes tissue stress
blisters as the liner pulls against the skin as it migrates distally back
into neutral elasticity. Water blisters are common if the patient finds the
liners wet on the inside from excessive sweat. This occurs with very hairy
residual limbs, liners that are too large and improper donning by the
patient to let air into the system.

Solutions:
1) Sweating: antipersperant can be used on the skin. if that does not work,
try Certain Dry (prescription antipersperant). A sheath can also be worn
under the liner without compromising the suspension. Proper donning
techniques. Proper cleaning/hygiene techniques. (I always have the patient
clean their liners with a mild soap. Anything that says anti-bacterial is
bad. These soaps contain hexaclorophene which irritate the skin if any soap
residue is left on the liner and damages the silicone material itself after
long time exposure)

2) Friction blisters: Check the liner sizing. A lot of time you measure the
liner properly and after the patient wears it for a few weeks, it compresses
the tissue to a size smaller than anticipated. Measure the residual limb at
an appointment late in the day after the patient has been wearing it for
several hours. compare it to your original measurements. A sheath can also
help with this. Also good hygeine can prevent small object from rubbing
against the skin inside the liner if the patient normally doesn’t wash it
daily. I always give 2 liners with every 3S leg (one to wash and one to
wear).

3) Socket design: Occasionally I come across a 3S socket design the cups
around the hamstrings like a PTS design. This is less necessary because the
liner will provide tissue support in that area. I open the hamstrings up
more on these sockets which has the added benifit of more range of motion.

I hope this is all helpful. If you need any more information please let me
know.

Michael Kogan, CP

> —–Original Message—–
> From: Orthotics and Prosthetics List [mailto:[email protected]]On
> Behalf Of Arthur Sirdofsky Cpo
> Sent: Tuesday, January 22, 2002 9:39 PM
> To: [email protected]
> Subject: [OANDP-L] Blisters
>
>
> I would like to get feedback from practitioners as to how
> they manage
> patients who develope blisters while wearing silicone liners.
>
> Thanks For Your Input,
> Arthur Sirdofsky
>
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