Re: AK susp. (Responses)

Re: AK susp. (Responses)

PP240Z

These are the responses I recieved from the following posting on AK
suspension.
Thank You,
Pat Peick

In a message dated 98-03-02 22:59:49 EST, you write:
 >Dear Colleagues,
 >I have a very determined obese patient who is an AK amputee. This occurred
 >several years ago and has taken till now to be healed and ready. Problem:
pt
 >deconditioned from W/C use only, standing endurance 2-4 min, waist is 50+,
 >Prox circ of residuum is 28 and dist circ is 23. Heavily scarred and very
 >loose tissue. Length is 80%. UE are good. Cognition is excellent.
Sound
 >side has instability in knee from old TKR. How would you suspend? My plan
 >is to use a 3mm ALPHA and ICEROSS lanyard. Pt is learning to don ALPHA
with
 >asst from spouse. All suggestions are welcome.

 In situations like this - sometimes it pays to use the KISS
 principle. I realize that the patient is quite obese, which is
 evident from the waist and residual limb circ. I might be tempted to
 use a stump shrinker with waist attachment to get good compression
 for a casting, then try to fit with a smooth walled socket (acrylic
 or the like), not a sticky thermoflex type socket. I would use a
 modified silesian belt suspension with either a cotton webbing or
 combination webbing/elastic strap. It might be able to be suspended
 even above the waist line with the modified strap to hold it up.

 I would think with a snug sheath - 2 ply fit you would achieve
 adequate partial suction suspension without the hassle of trying to
 roll up a silicone sleeve or alpha style liner. If she is motivated,
 this socket could help shrink her down to a consistant volume whereby
 you could then try the alpha liner. (Of course you mention that there
 is much scarring, and an alpha liner or similar may be needed
 depending how sensitive or deep the scarring is.)

 Just my opinion and some experience with patients such as you
 describe. In any event, you have a challenge to say the least. Good
 luck.

 Andy
  >>

In Alabama we have a population that is normal from what you have described.
You are headed in the right direction but I would also suggest flex socket
with rigid frame-with the Tes belt as aux. suspension, the person will be
sitting alot and will require the comfort. The most important ingredient that
you have is the assistance by his wife. If you got any question, write to me.

You might contact Allen Hammer, CPO, at the JE Hanger facility in Knoxville,
Tennessee. He as taken care of a patient of mine, very obese woman with knee
disarticulation amputation following an infection of a very old total knee.
She sounds very similar in many respects to your patient. Has total knee on
other side. Very motivated but very deconditioned. Allen has worked very
hard and come with a satisfactory set of compromises. I do not know the exact
details so I would refer you directly to him.

Ed Jeffries, MD


 I have been hand casting obese AK's while standing with no brims to get a
great anatomical mold. I use one hand to form the medial brim section and the
other to form the lateral wall and the index finger to find the seat. by
wrapping high and forming all this and snuggly wrapping the limb, I then have
them weightbear as I hold. I then modify the mold Without too much definition
but reduce the measurements for a snug 1 ply fit. Reduce proximal more than
distal. Then fit an eval socket. By having a snug anatomical socket for these
people that is a combo of a Quad, Plug fit, They have all just worn socks and
sunk in and if the top is well conforming but a little tighter than the distal
it won't slip at all. I use this technique with a green dot. Simple for you
and VERY simple for thr wearer.
                   Tom Whitehurst

if he can don an alpha liner, or don one with assistance, that would be great.
i've fit a few AK pts. with alphas and have had good success. good luck.


Hi PP240Z
First I feel that it would help the sound limb not to being traumatized, and
over used. Unless she using a HOYER lift or sliding board, she is using the
sound side for dressing, bathroom and transfers.
Suspension is by 3/S liner, cause you can graduate the thickness. Ten ply at
the bottom and two ply proximally. Just like toothpaste tube getting hard and
stiff when you compress the toothpaste. It keeps the soft tissue compress and
stable, the liner will also make the scars smooth.
You also don't need ishium weight bearing on these persons. There is no way
you are going to get it anyway! I done over seven socket all circumferences
were over 25 proximally. You can get a comfortable socket fairly easily.
Shape the socket to eliminate roll proximal, volume compression in mid shaft,
and even some distal end bearing. Using socks to allow for volume change. You
can lock that socket on with only 1/8 pistoning.
Our next step is allowing the patient to adjust the volume in five seconds.
(please not a bladder) I feel that bladders can't work, cause you can't make
a balloon square, and the aspect of the pressure is only a small area of the
bladder.
There is a large group of these patients out in the community that don't wear
limbs, cause we can't fit there limbs comfortably.

(((((((((((((((((((((((((((((((((((((((((((((
<Email Address Redacted>
John G. Russell Jr.
3161 Putnam Blvd.
Pleasant Hill, CA. 94523
Phone 510-943-1119


I have had several of these and have had best success using an Iceross two
color insert(the 45cm stretches a lot)and our own lanyard. We laminate a
channel in the distal end of the socket and then attach 1 inch double
thickness dacron webbing to the iceross with a college park foot bolt that has
been cut down in length. The iceross does not seem to roll down as much as
the alpha. With that much residual tissue we usually do not need the
protection of the alpha.
Good Luck, Al Ingersoll, Winkley Orthopedic