Obese B/K patient socket design, suspension??/Responses

Obese B/K patient socket design, suspension??/Responses

Thank you to all who responded, I will try to use the best of all of your
ideas and I will let you know how she does!

Jef A. Zeller, RTP
<Email Address Redacted>

Here is my original post:

Good evening list members,

I have a below knee female patient who is diabetic. She has been fit with an
Alpha gel locking pin system X-Large 6mm. She was 274 lbs. as of Oct. 99 and
is now 307lbs. She ambulates with the walker but has consistently had to deal
with rotation in the socket, due to the fleshy condition of her limb.

She is now wearing 5-ply of sock over her Alpha and is continuing to get
rotation. Her thigh is SOOO fleshy it is causing the Alpha to roll down over
proximal edge of socket and has cut thru the gel and fabric. Her thigh has
developed a very hard mass above the posterior trimline of the socket, which
her doctor told me today is just a hard area of edema.

I need to get her new liners, because they are shot. And we are going to do a
socket change to tighten up the socket. I would appreciate any ideas or
thoughts to best fit this patients situation. Has anyone tried to sew a y
-strap to the proximal edge of the Alpha and go up to a waist belt?? She is
a sweet lady who has her other leg that is developing ulcers, so we need to
get her comfortable and ambulating.

Thank you for your input and this forum.

Jeff A. Zeller, RTP
<Email Address Redacted>


I have had similar experiences over the years with redundant tissue and gel
liners. I would offer the following recommendations.
1. Use a firmer and/or thinner liner. Perhaps iceross or TEC. The less
firm, thicker liners add to rotational instability in obese patients.
2. It is hard to believe that she gained 32 pounds and has shrunk out of
her socket. This tells me that either the socket never fit correctly or her
edema is out of control. Either way, I wouldn't proceed with new socket
until the problem is identified. If her edema is out of control you might
try using a tight fitting liner as a shrinker. We have done this
successfully when other compression shrinkers wouldn't work. You may have
to provide a series of liners as her edema responds and gradually decrease
the size.
3. The liner should not be suspended by a waist belt because it will tear
the liner and possibly cause shear force to the skin that would cause an
abrasion. However if the patient can successfully wear a waist belt, I
would consider not using the gel liner at all and simply use prosthetic
socks as they would be more durable, easier to adjust to residual edema by
changing sock ply, and possibly the belt could be attached to a strap not
only for suspension but also to help control the rotational problem.
4. W/O seeing your patient I'm reluctant to recommend a suspension strap,
however should you decide to not use the gel liner, you might consider a
simple anterior fork strap with a PTB prosthesis since the thigh is usually
too large for a PTB cuff.
5. I would stay away from volumetric socket designs and make use of ML
pressure to stabilize the socket. AP weight bearing surfaces will be less
defined due to the obesity. It is not unreasonable to expect proximal
displacement of redundant tissue if the socket is to fit properly. To the
point where redundant tissue may actually sag over the proximal aspect of
the socket exterior. Hence the compromise of suspension straps.
6. Although I recommend this last option with caution I have used it. If
the patient cannot wear a waist belt, and a shoulder strap is out of the
question, I have used pin suspension with a liner that was cut off very
short so as to not encumber the redundant tissue of the thigh. This should
be a last resort.

Regards,
John