Thanks to the many people who wrote addressing the problem with my patient.
I am posting the responses. Unfortunately, she is now struggling with an
ulcer on her heel, plus difficulties with finding a physical therapy center,
and transportation to doctor offices, etc. I want to get her to wear the
prosthesis, even if she is only sitting, but much of her prosthetic
training will probably be put on hold until the ulcer resolves. Wish her
luck, everyone! Paula Martinek, C.O.
I have a very heavy BK patient. She is about 60 years, diabetic, weighs
appox 250 to 300 lbs. The residual limb is not a bad shape, however, her
thigh above the knee is extremely fleshy and flabby. (Circumference of upper
thigh is 29 inches). My problem is finding shrinkers and socks that do not
roll down her leg. My other problem is suspending the prostheses. I have
been using a neoprene suspension sleeve now because I do not think she would
tolerate a thigh lacer, because of weight, bulk, and difficulty of
application. She is now able to stand with assistance, but unable to walk
more than a step or two. I do not think she will be using her leg for more
than transfers, but would like for her to have it for these purposes. If
anyone has any experience with fitting a patient such as this, I would be
happy to hear from you. Sincerely, Paula Martinek.
I have a patient who must weigh 350 lbs. We found the ALPS suspension
sleeve (it’s silicone) to be a big help with severely obese patients…. it
seems to stay out and not roll down.
As for shrinker and socks, you might try coolmax socks (don’t know the brand
name)– they are more elastic than most socks. And if the shrinker rolls
down, you can modify a shrinker by sewing dacron straps to it and attaching
those to some type of waist belt. Not an elegant solution, but it works.
Good luck,
Bill Lifford, C.P.
have a similar patient and have had great success fitting with 3S,
namely a 9mm alpha liner. To keep the socks and shrinkers up I use a
skin adhesive, used for TED hose.
Lane Ferrin CP
My best success had been to use a silicone suction suspension, for the
following reasons:
1) The silicone suspension is easy for a person of bulk to don. Merely step
into the prosthesis…and, if there is excessive redundant tissue, a lanyard
system can be used so the patient pulls the tissue in.
2) Choose the appropriate size ICEROSS or equal liner and trim the top along
a very wavy line. By trimming the wave (like a sine wave) up to an inch or
better, you essentially increase the circumference of the top of the liner a
relatively enormous amount.
Try to keep the top of the liner above the top of the socket as high as
possible–at least a couple inches with ICEROSS…four is
better…but…….You just don’t want the liner to slide down into the
socket…
This approach has worked well for several patients that have a very abrupt
and large difference in the dimension of their thigh just above the knee.
Hope this helps a bit…
JTA
J. THOMAS ANDREW, CP
ABILITY PROSTHETIC SYSTEMS, INC.
SLC, UT
Don’t use sleeve….it’ll just be a pain for her to don and doff. A waistbelt
would be better, but cumbsome. Why not use a locking liner?
As for shrinkers, you may have to use a waist belt to keep it from rolling or
try
“IT STAYS” used for compression hose stockings.
Chad Marquis, CPO
Regards your BK patient, how about an OWW Alpha Locking liner Xlg. I am
wearing one, and it is wonderful. Jeff
ALPS makes the EZ Sleeve which is very stretchy and is probably better than
the neoprene sleeve. Of course there is always the wait belt!
Mark Benveniste CP
I had a similar patient last year. 200-210lbs. I tried sleeves and cuffs
nothing worked till I tried an Alpha locking liner. I took a cast of her
leg end of stump to as high on her thigh as possible using Delta lite
casting tape. I then filled the cast with caliber foam just for rigidity. I
then pulled a stockinette over the mold and stretched an Xlarge Alpha 6mm
locking liner over it and let it set overnight to retain the shape, which
it did. Worked great for my patient so it might be worth a try. If you have
any questions about working with the Alpha Liner call Ohio Willow Wood and
they can help.
Stump bandaging is maybe the best way to go with this type of
patient…shrinkers will continue to give you problems in my opinion.
I have used 3-S suspension and PTK/PTS BK’s with these types before, with
some success. These negate the difficulty with rolling socks etc. (I have
one similar lady whose socket will hold about 7 litres of water – a little
under 1/2 gallon!)
Good Luck!
Have you considered PTS suspension. I have found this to work better in
fitting fleshy thighs.
