"One way" valves for transtibials Responses-(part two)

"One way" valves for transtibials Responses-(part two)

Randall McFarland, CPO

RESPONSES (continued)

I use the one way valves all the time in bk suction sockets. If the
socket is a sheath fit or 1 ply fit they allow the limb to get all
the way in the socket. They are effective because when they get
clogged, the limb wearer is on the phone to me saying they are not
getting into there socket or are pistoning. Without it, there is air
trapped in the socket when they roll up the sleeve and they piston.
If they are wearing 5 ply, the valve doesn't do much good because
air is within the sock and they piston some from that.
 Tom Whitehurst CPO

I have used these valves for sometime, and find them an excellent form of
auxiliary suspension. I have used a variety of brands such as TEC, USMC's,
but prefer the BK LYNN valve from ESP. This is a very simple device which is
easily retrofitted to any TT socket. Finding a durable sleeve to use as a
seal in conjunction with these valves can be difficult. I have found the
Silipose Sleeve provided through SPS works well although durability is a
problem. As soon as a hole develops the suction is lost.
   Billing is another difficulty. In my experience Medicare will not allow
reimbursement for these with the use of preparatory prostheses. A 99 code
must be used as the BK Suction Socket (L5647) code is inappropriate for
expulsion valves according to AOPA's Coding Committee. Hopefully a separate
code will be obtained for this valuable alternative.
Joel Kempfer CP FAAOP

I have played with check and difinitive sockets, with and without the valves,
and I'm not sure of the actual validity of thier effectivenes when the device
is donned standing and weight bearing. When the device is donned in a knee
flexed/patient sitting environment, it seems to be effective at expulsing the
distal air. so I think patient habits and ability to work the prosthesis are
key to your question.

I have used explusion valves on a limited basis. I find the best candidates
are Transtibial patients with stable residuums - meaning minor volume
changes no more than a three ply variance maximum. My experience is a nylon
sheath only fit is best. I have had the best longevity with the Alpha
sleeve because it is reinforced in the socket proximal brim region. I have
not used an explusion valve on a Transfemoral as of yet.
Joe Perry CP

I recently had a great experience with the use of a one-way valve in a
transtibial prosthesis. I have been seeing a woman for a while who had lost
her leg secondary to vascular disease. Since her amputation, she has always
had a problem with the feeling of pins and needles and an aching sensation
after wearing her prosthesis for extended periods of time. She has noted to
me that her residual limb is cold all of the time and that she doesn't
believe the aching sensation is from the prosthetic socket because it feels
like a deep aching sensation. I asked her to see her vascular surgeon and
ask him if there was anything that he could do to improve the circulation in
her residual limb and he declined saying that there was nothing more he
could do. I have made her numerous sockets with different types of liners
and means of suspension in hopes of solving this problem. some systems were
better than others but none were acceptable to both of us. She had been
using the supracondylar method of suspension and was not very excited about
trying a sleeve that came up to her thigh. I told her about the one-way
valve system and how it has been reported to improve circulation by pulling
tissues out against the walls of the socket. By this time, we were both
willing to try anything to make her comfortable. To see if it would work, I
applied the suspension sleeve from her socket on to her thigh and installed
a one-way TEC valve (it doesn't matter what brand of valve you use) through
the bottom of the socket and into the pylon. The results were immediate.
We were using the same socket that she had been wearing for the last few
months. She wore the prosthesis for an hour in the office and walked on it
for approximately 45 minutes. She made the comment several times that she
felt like her leg was in a warm electric blanket and that she can't
remember when she'd had that warm feeling in her limb. I have to say, I was
amazed. When we took her prosthesis off, her limb was as warm to touch as
her sound side. She can't wait to get her new prosthesis. the valve system
is an extremely positive means of suspension for any amputee, but if you are
using it for someone that has compromised circulation, I highly recommend
it. I'm sorry this was so long winded, but I hope it helps you.
   Kirk Simendinger CPO

i use a one way suction valve with suspension sleeve as a usual practice
now. i am actually doing research on that subject. i have used many of the
one's available on the market. results so far are very good. the only
problem is the sleeve; it does not last very long. I have written an article
about the way I do it in the British Association of prosthetist and
orthotist magazine.
i think suction suspension can have many advantages over a pin/shuttle lock
suspension and we will be seeing more suction tran tibial socket suspension
in the future.
Abdo Haidar