Page # 1 - Burn Victim Replies (Thanks to all who contributed)
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Page # 1 - Burn Victim Replies (Thanks to all who contributed)
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Tough one for you. Burn patients alone are easy to fit because of their
tolerance after skin graphs. Your situation is more difficult. My first
thought is silicone liner (thick) with 3 to 5 ply fit. You will have to
determine if locking pin suspension will be tolerated distally. I chose
silicone liner (Iceross) locking pin design whenever I can. I also suggest an
inner flexible socket design with windows at adhered scare tissue areas. If
you cannot obtain sufficient support and contact behind her knee, you have no
choice but knee joints and thigh lacer. I also would choose a foot and
alignment that has minimal forces directed at her residual limb. Write or
call with any questions. I look forward to your postings and results. Would
you please let us/me know your results after her prosthesis is used. All of
us may be able to help later if concerns develop. We all have them.
------------------------------------------------------------------------------
------------------------------
I think you need to establish how pressure/ friction tolerant her tissue is.
Sometimes the only way is to tell is to just try it and see. It would be
nice if
you could avoid the femoral component.
You are going to get a lot of liner recommendations. I have two suggestions
in
this regard:
1. Give her a scrap piece of liner to try wearing against her skin for a few
days. I have used the top band cut off of a liner to test tolerance an
a
pt who reacted to another liner.
2. Don't cut your liner until you determine that the femoral component isn't
needed. Besides, she might like the protection it affords her for
sitting.
3. (ok 3 suggestions) I understand that silipose makes products for burn
victims. They may be able to guide you in silicone type selection. They
also
have a new liner out although I haven't tried it. I personally have had
good
success with the alpha liner on scar tissue but I haven't had that
severe a
case.
------------------------------------------------------------------------------
------------------------------------
What about a corset type of setup going up to a quad type socket at the
pelvis. Line the corset with silicone similar to an alpha liner. She's only
100# so the silicone should prevent further breakdown of her skin grafts.
Cleanliness is of utmost importance to prevent further infection which will
start at the skin and go deeper.
------------------------------------------------------------------------------
---------------------------------------
The custom Tec insert with a lubricant used is my first
choice. The Alpha or new Dermo from Iceross would be second.
Both have built in lubrication which I think is essential for scar
tissue.
------------------------------------------------------------------------------
------------------------------------
I have worked with some patients that have similar residual limb problems and
they are always a challenge. We had one gentleman with a residual leg ( tt)
that
was covered with 70% scar tissue. The final design was a custom tec liner, No
reinforcement (due to flow restriction) fit over original a&d ointment. The
ointment prevents any skin friction and the liner can flow much better without
the reinforced top. Just remember that tec liners cannot be used if there is
an
area that cannot tolerate at least some compression eg. neuroma.
------------------------------------------------------------------------------
-------------------------------------
one day a tourist came in my office to buy supplies, who had the same
challenges as you are confronted with, his prosthetist tried everything which
led him to make his pelite liner with a poly/ethyl. inner socket [between
skin & pelite ] according to the amputee he was pain free. ------- i believe
the p/e inner socket, which was very thin, reduced friction
also this was prior to the pin system liners.
good luck
------------------------------------------------------------------------------
------------------------------------------
I have done a few cases like this and have success with the TEC liner (the
only time I will use it is in cases such as this). Messy, heavy, expensive,
but works well for extremely marginal tissue.
------------------------------------------------------------------------------
-------------------------------------------
I would use a gel liner. This will give the patient's skin protection, from
several different forces. If you can not use a off the self liner then try
TEC's custom made one. Some of the liner have things added to help the skin.
------------------------------------------------------------------------------
-------------------------------------------
f you have experience with the TEC custom liner I think that it would be your
best option. I have several patients with really gnarly residual limbs due to
severe burns/trauma and/or large areas of grafted, invaginated or adherent
scars who could not do the things they do with any other system I am aware
of. If you haven't had the course I highly recommend it before getting into
it. They are really different animals and require that the patient really
understand the system, the importance of compliance and management of volume
changes.
If your patients are like mine be ready for unbelievable shrinkage of the
residual limb.
I fit a 47yr. old lady who had severe burns at age 5 and wore BK jts and
thigh lacer all her life. She had a real ice-cream cone shape and super
mature appearance. She shrank over 1 inch in circumference almost uniformly
the entire length of her limb in about 6 months. The good news is that today
she is a manager for a big retail store chain and is on her feet as much as
anyone I know (without a thigh lacer). I have a similar story about an AK who
has about three inches of distal femur with nothing but grated skin (no soft
tissue) covering it, as well as several others.
Beware. They are tricky to fit and manage and I have done my share of redo's
because the limbs shrank so much in a very short period of time. I recommend
a check socket that is wearable for a minimum of three weeks before
proceeding to a second check socket if needed and then the definitive socket
only after the volume settles down. Even then count on making a new socket
and/or liner and socket in six months or less.
------------------------------------------------------------------------------
-------------------------------------------
If you haven't already tried, Alpha locking liners or the new Silipos locking
liners have worked for me. I had a young man , burned in a house fire 70-80%
of his body. Major respiratory involvement and he's bilateral bk with nothing
but graft sites, some muscle and bone despite attempts to save one of the
legs. He has successfully ambulated for 3 years now. One of his legs was so
skinny that we had to make a custom TEC liner and roll an Iceross locking
liner on top of it since we could not put any pressure on some very delicate
graft sites above the knee.
------------------------------------------------------------------------------
------------------------------------------
I believe my first attempt with this case would be to try a PTB socket with
a 6 or 9 mm ALPS Easyliner locking suspension , but I would send this
individual home with the liner on a trial basis first to assure skin
compatability. My best previous experience with fittings on burned or
globally scarred residuaL limbs has been with a medical grade silicone
interface such as a Silipos Silosheath. Silipos also has a locking liner of
their own which contains vitamins in the silicone gel which I have used and
seen very favorable response on fragile skin in BKAs.
tolerance after skin graphs. Your situation is more difficult. My first
thought is silicone liner (thick) with 3 to 5 ply fit. You will have to
determine if locking pin suspension will be tolerated distally. I chose
silicone liner (Iceross) locking pin design whenever I can. I also suggest an
inner flexible socket design with windows at adhered scare tissue areas. If
you cannot obtain sufficient support and contact behind her knee, you have no
choice but knee joints and thigh lacer. I also would choose a foot and
alignment that has minimal forces directed at her residual limb. Write or
call with any questions. I look forward to your postings and results. Would
you please let us/me know your results after her prosthesis is used. All of
us may be able to help later if concerns develop. We all have them.
------------------------------------------------------------------------------
------------------------------
I think you need to establish how pressure/ friction tolerant her tissue is.
Sometimes the only way is to tell is to just try it and see. It would be
nice if
you could avoid the femoral component.
You are going to get a lot of liner recommendations. I have two suggestions
in
this regard:
1. Give her a scrap piece of liner to try wearing against her skin for a few
days. I have used the top band cut off of a liner to test tolerance an
a
pt who reacted to another liner.
2. Don't cut your liner until you determine that the femoral component isn't
needed. Besides, she might like the protection it affords her for
sitting.
3. (ok 3 suggestions) I understand that silipose makes products for burn
victims. They may be able to guide you in silicone type selection. They
also
have a new liner out although I haven't tried it. I personally have had
good
success with the alpha liner on scar tissue but I haven't had that
severe a
case.
------------------------------------------------------------------------------
------------------------------------
What about a corset type of setup going up to a quad type socket at the
pelvis. Line the corset with silicone similar to an alpha liner. She's only
100# so the silicone should prevent further breakdown of her skin grafts.
Cleanliness is of utmost importance to prevent further infection which will
start at the skin and go deeper.
------------------------------------------------------------------------------
---------------------------------------
The custom Tec insert with a lubricant used is my first
choice. The Alpha or new Dermo from Iceross would be second.
Both have built in lubrication which I think is essential for scar
tissue.
------------------------------------------------------------------------------
------------------------------------
I have worked with some patients that have similar residual limb problems and
they are always a challenge. We had one gentleman with a residual leg ( tt)
that
was covered with 70% scar tissue. The final design was a custom tec liner, No
reinforcement (due to flow restriction) fit over original a&d ointment. The
ointment prevents any skin friction and the liner can flow much better without
the reinforced top. Just remember that tec liners cannot be used if there is
an
area that cannot tolerate at least some compression eg. neuroma.
------------------------------------------------------------------------------
-------------------------------------
one day a tourist came in my office to buy supplies, who had the same
challenges as you are confronted with, his prosthetist tried everything which
led him to make his pelite liner with a poly/ethyl. inner socket [between
skin & pelite ] according to the amputee he was pain free. ------- i believe
the p/e inner socket, which was very thin, reduced friction
also this was prior to the pin system liners.
good luck
------------------------------------------------------------------------------
------------------------------------------
I have done a few cases like this and have success with the TEC liner (the
only time I will use it is in cases such as this). Messy, heavy, expensive,
but works well for extremely marginal tissue.
------------------------------------------------------------------------------
-------------------------------------------
I would use a gel liner. This will give the patient's skin protection, from
several different forces. If you can not use a off the self liner then try
TEC's custom made one. Some of the liner have things added to help the skin.
------------------------------------------------------------------------------
-------------------------------------------
f you have experience with the TEC custom liner I think that it would be your
best option. I have several patients with really gnarly residual limbs due to
severe burns/trauma and/or large areas of grafted, invaginated or adherent
scars who could not do the things they do with any other system I am aware
of. If you haven't had the course I highly recommend it before getting into
it. They are really different animals and require that the patient really
understand the system, the importance of compliance and management of volume
changes.
If your patients are like mine be ready for unbelievable shrinkage of the
residual limb.
I fit a 47yr. old lady who had severe burns at age 5 and wore BK jts and
thigh lacer all her life. She had a real ice-cream cone shape and super
mature appearance. She shrank over 1 inch in circumference almost uniformly
the entire length of her limb in about 6 months. The good news is that today
she is a manager for a big retail store chain and is on her feet as much as
anyone I know (without a thigh lacer). I have a similar story about an AK who
has about three inches of distal femur with nothing but grated skin (no soft
tissue) covering it, as well as several others.
Beware. They are tricky to fit and manage and I have done my share of redo's
because the limbs shrank so much in a very short period of time. I recommend
a check socket that is wearable for a minimum of three weeks before
proceeding to a second check socket if needed and then the definitive socket
only after the volume settles down. Even then count on making a new socket
and/or liner and socket in six months or less.
------------------------------------------------------------------------------
-------------------------------------------
If you haven't already tried, Alpha locking liners or the new Silipos locking
liners have worked for me. I had a young man , burned in a house fire 70-80%
of his body. Major respiratory involvement and he's bilateral bk with nothing
but graft sites, some muscle and bone despite attempts to save one of the
legs. He has successfully ambulated for 3 years now. One of his legs was so
skinny that we had to make a custom TEC liner and roll an Iceross locking
liner on top of it since we could not put any pressure on some very delicate
graft sites above the knee.
------------------------------------------------------------------------------
------------------------------------------
I believe my first attempt with this case would be to try a PTB socket with
a 6 or 9 mm ALPS Easyliner locking suspension , but I would send this
individual home with the liner on a trial basis first to assure skin
compatability. My best previous experience with fittings on burned or
globally scarred residuaL limbs has been with a medical grade silicone
interface such as a Silipos Silosheath. Silipos also has a locking liner of
their own which contains vitamins in the silicone gel which I have used and
seen very favorable response on fragile skin in BKAs.
Citation
“Page # 1 - Burn Victim Replies (Thanks to all who contributed),” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 26, 2024, https://library.drfop.org/items/show/214646.
