Silicone Liners and Blisters

Silicone Liners and Blisters

John T. Brinkmann, CPO

12/8/1999

The following are responses to my question regarding blistering and
silicone liners. Thanks to all who responded. I tend to fit the
Comfort liners tight, which may be contributing to the problem. The
patients I have seen who have this problem have been diabetic, with a
sair amount of redundant tissue.

John T. Brinkmann, CPO


I have seen this problem in the past and determined it was caused by the

patient's donning technique. After rolling the liner up properly, some
patients would lift the proximal edge and cinch up that last little
bit.
This lifting and pulling would cause a shearing of the soft tissue at
the
proximal edge resulting in redness then blistering. I advise my patients
to
roll the liner then stop, resisting the urge to tug that last bit of
liner.

Joel Kempfer CP

If you are trimming your liners too low, the tension along the proximal
edge will be high and cause blisters. Leaving them as high as the pt
will
allow will likely limit the problem.

 Try using a lubricant in the effected areas to reduce the friction.
Only a small amount is needed. This has helped some of my patients in
Fl. during the hot months.
 Best Steve

I have used Iceross for 15 years. I always instruct the patient to use
A&D
ointment if areas get red and or develop blisters. Especially new
patients.
The problem is, the tissue is being pulled beyond its capacity to
withstand
the new pulling from the Iceross. Within a few weeks (on a new patient),
the
skin toughens in which you should not have the reddening or blister
problems.

 Jake C.P.


Mr. Brinkman,

I have experienced the same. The problem was evident on the proximal
trim
of the liner. I have not experienced any problems, as you have
described,
at the location of the mesh reinforcement. Perhaps this has been
overlooked
in light of the more apparent proximal problem.

My experience with the comfort liners is limited, but it seems apparent
that
the problem exists with diabetic users. Amputees with other etiologies
seem
to get along well with this liner. Have you contrasted this problem
with
your patient diagnoses? Please let me know your results.

As of yet, the only resolve has been to replace the liner with a
non-silicone liner. A proximal bead of A&D was not effective, nor was
trimming the liner at a more narrow taper of the thigh (to reduce
tension on
the circumference). The supplier was very good about the return item.

Possibilities:

1. The silicone presents an abrasive element at the liner/skin
junction.
FYI: The cutting tool to provide a nicely beveled edge was used on all
the
liners.
2. There is a negative reaction (silicone vs insulin?) between the
fragile,
diabetic tissues.

Please let me know of your other responses, and thank you for your
inquire.

Good holiday

Barry Jones, CPO
Brownfield's Inc.

Have you tried; for the proximal edge, to cut the Iceross in a wave
pattern, it distributes the pressure over a greater surface area, make
sure the cutting of the Iceross is with a rounded edge though.
The length of the matrix: is at what height? Check the tissue type
(fleshy, muscular etc) the tissue at the proximal matrix may not need as

much stabilisation.....you can customise the length of the matrix in the

Iceross....this is successful.
Good luck, love to see your responses to your question.
regards,
Merrilee McClelland
Prosthetist Orthotist

I have. It is a shearing blister. Rub a small amount of A&D ointment
around the proximal portion of the liner. Make sure the liner trim is
smooth.
Good luck, Bob

Proximal irritation seems to be fairly common with many liners and is
ameliorated with a little A&D oint or silicone oil on the proximal
border
area.
Mark Benveniste CP