Thankyou all for your replies, I have much to try now. Herewith replies for
the edification of all subscribers.Richard Ziegeler
The problem you describe might well be the friction componentof the
silicone
sleeve that folds rather than ‘shrinks’ with the skin. Use some vaseline,
or petroleum parrafine. This allows relative movement without abbrasion.
Hair and hair roots also remain better protected, and loss of suction is
reduced.
Regards Jacob Boender, Prosthetist, Orthopaedic Services Ltd, UK
Hi this John Russell
To start why 3/S have the problem, is that they increase their
activity.Since 1976 I have not use cuff suspension, PTS-sc-sp.We do almost
all 3/S BK sockets, our solution is PTPC, posterial tibia platoteu
contaiment. The wall is higher on the medial side! Notched out for the
hamstring insertion.
If you learn how to do this well no adjustments in that area.
thats all
I have used several ALPS silicone liners since 1993, and have only found
that
problem to exist with one patient. It is extremely critical that the
patient
be shown the proper location to apply the A & D ointment prior to donning
the
silicone socket. If your patient goes without this ointment, it’s
practically
inviting trouble.
As far as modification to your mold, practice restraint when modifying the
posterior section. A very simple flair is sufficient in 99% of the cases. I
have even gone without modifying the posterior wall at all and still
hadsuccess. Trust your pressure casting techniques as they are the key to
successful fitting silicone suction sockets. And don’t forget the ointment!
Sincerely,
Joseph F. Carideo Jr., CP
The problem can be solved by applying a lubricating gel to that area.
The relative motion of the liner with respect to the residual limb is
highest in this area. Application of a lubricating cream or gel
alleviates the problem. Alps makes a lotion specific to this
application.
Aegis is a competitor of ALPS, ICEROSS, et alii…
Their design twist on the liner theme is a 45 degree preflex at the knee
which reduces pressure at the patella as well as popliteus/hamstrings. The
material is similar to the ALPS silicone. They are coming out with a
similar design (called the Aegis Z) using softer material…more like Ohio
Willow Wood’s Alpha liner (who also makes US Mfg’s “Luxury Liner”; same
liner – different cloth color).
Seattle Limb Systems has been distributing their product. However, I
believe they have gone out on their own.
I hope this info helps.
Dave Procter
We have tried the new Aegis silicon liner by E.S.P. , sold by Seattle Limb
Systems (M.I.N.D.)
The liner is pre-flexed, therefore eliminating some of the “bunching” that
may be causing some excessive presssure in the popliteal region. The
patients
that have tried this option have been very pleased with the results, and
have
nor experienced the problem again.
Paul E. Prusakowski, CPO
Shands Hospital at the University of Florida
In reply to your posting.
As you probably know, much of the posterior brim discomfort comes
from the silicone material, bunching up posteriorly upon knee flexion.
We have had some limited success with the Aegis liners(I believe they
are distributed by Seattle Limb Systems). They are made in a pre flexed
position and seem to reduce the amount of material wrinkling and
bunching up posteriorly. We have only tried a couple so we do not have
a lot of experience with them yet.
Hope this helps.
Steve Fletcher, CPO
Shands Hosptial at the University of Florida
In the Journal of Prosthetics and Orthotics Summer 1997, there is a very
good artical written by Chris Lake and Terry Supan regarding 3-S and why
may prolems occur. If need be I would be glad to fax you a copy.
Meanwhile, be sure the amputees are not pulling the 3-S on like a sock
at the top. Fillauer and ALPS have a lot of strength lengthwise and if
stretched while donning will cause the tissue to shear under the
tension. Also try having the amputee use a prosthetic sheath under the
3-S to help break the skin tension. Make sure to tell the amputee to
release the shuttle lock if sitting with the leg bent for long periods
of time. Lastly, try a different 3-S.
Tom Current
Richard Ziegeler
E.C.A.T
