Summary part 1 : pin suspension / fleshy limbs

Summary part 1 : pin suspension / fleshy limbs

Ted A. Trower

5/12/2000

My first attempt to post this response listing was rejected as it was too
long. I've broken it into two parts for that reason.

Ted

My question was:

 -----Original Message-----


I've been noticing a pattern lately of much greater difficulty fitting pin
suspension systems (Alpha) on individuals with very soft, fleshy limbs.
The absence of muscle tone seems to be more the issue than is the total volume
of tissue. The thing I've noticed is that by the time the socket is fully
stable on
the limb the socket is so tight that the knee is beginning to push up out of
the socket. Elongating the tissues during casting seems to help with this
somewhat but
not entirely and is specifically not advised by the folks at Ohio Willow
Wood. I'd be interested to hear other prosthetists thought and experience in
this area. Is it reasonable to state that pin suspensions are contraindicated
in the presence of a flabby, fleshy limb?

Responses have been interesting:
--------------------------------------------------------------------------------

>From our experience with a range of silicone suspension systems and liners
>the fleshy residual limb with redundant distal tissue creates a problem with
>donning the sleeve/liner and and maintaining a satisfactory fit. The distal
>matrix within a number of available liners can help stabilize the tissues.
>As with all prosthetic socket designs, a customized fitting and approach is
>required. There is no one solution.
>David Lee Gow
>Manager, Prosthetics & Orthotics
>

--------------------------------------------------------------------------------

In some cases I have used old socks various plys and cut the ends off.
Sandwich these cut socks between full length socks, therefore tightening
the proximal area of the socket without to much lifting up distally. Its a
challenge but stick with the total contact concept. As the patients progress
use a thicker liner. A good idea as a predictor is maybe to start with a 3mm
or 6mm liner,
Best Wishes,
John Izak CPO
Lawall Prosthetics Orthotics
Philadelphia Pa

--------------------------------------------------------------------------------

 My experience with large residuums and suction susp. inserts with
locking pins has been a mixed bag. In general the softer the tissue the
less success and more problems with rotation/elongation. The reinforced
silicone inserts have been the most successful. There is no need for the
extra thickness/padding of the gel type inserts because there is usually
an abundance of soft tissue padding. The extra gel just creates more
rotational problems. If you use thin (3mm)
gel (Alpha)type inserts, they wear out quickly and the distal umbrella
washers pull distally (elongate the residuum).

I have successfully provided this type of suspension to one 430lb.
individual who had bilateral trans tibial amputations. He was very dark
and had very tough skin. I used the Alps reinforced (blue distal end)
clearpro inserts. Although he was very large, his residuum were very
solid. The muscle tone was good (Good myodesis surgery).

If the tissue is like jell-o, you might want to try suction susp. insert
without a pin lock. Use a one way (expulsion) valve and gel type
suspension sleeve instead. I have had success with the OWWC suction
block.
I hope this helps.

James M. Mc Coy, C.P., L.P.


--------------------------------------------------------------------------------

I met you at the 96 cycling track in Atlanta, with Dory.
No, flabby, fleshy, and bulbous limbs should have pin suspension systems,
but not Alpha. We have routinely used the 3/S system taught by Carlton. Once
you have compress the tissues so that the bone does not flop around inside
the limb tissue, you will not want do it any other way. We have modified the
3/S liner and made it graduated, 8-10 ply at the distal end, and 2 ply at
the knee. No off the shelf does that.
Since 96 we have been using the VGAP socket that is patient adjustable A/P,
which you saw at the 96 track meet. From the experience that we have with
3/S custom liner I feel strongly that elongating the limb's tissue with a
liner is the wrong way. To me this hydrostatic theory makes no sense.
That's all for Now, John Russell


--------------------------------------------------------------------------------
Ted A. Trower C.P.O.
A-S-C Orthotics & Prosthetics
Jackson, MI, USA