Gel-type liners as shrinkers-Responses

Gel-type liners as shrinkers-Responses

Randall McFarland, CPO

Here is the ORIGINAL QUESTION:

     I have seen gel-type socket liners marketed as prosthetic shrinkers.
In my practice, I routinely have my clients wear a shrinker before I cast
them (unless they are wearing a prosthesis). For new wearers, I start with
a lightweight shrinker and move them to a strong one (up to 40-60 mmHg) as
tolerated to hopefully prolong the useful fit of the soon-to-be-casted
prosthesis.
     For those of you who have used liners as shrinkers my questions are:
When do you use them in your pre-prosthetic protocol?
For what circumstances do they work best? When are they not a good idea? Are
they effective for edema reduction and shaping?
     I will share your comments to the list. Please differentiate your
theories from your actual experiences.


 RESPONSES: (separated by a blank line)

  I don't truly think of locking liners as effective shrinkers, but I do find
that if I send a patient/client home with a locking liner after the casting
procedure, so that he/she can practice donning and doffing, and be sure
his/her skin is compatible with the selected interface, etc. most times,
the patient/client tells me, when he comes back, that he's been using the
locking liner more than the shrinker because it's more comfortable. So I
assume that means at least he's been using something to establish a
consistent volume in his residual limb. And that's, at least, something to
rely on, and document, if necessary, when providing the Initial Socket.
Barry

For over 6 years, certain centres in Europe have been using Iceross
silicone sleeves in the early post-operative rehabilitation of Amputees.
The best documented and analysed use of this technique is a 5 yr study that
has been carried out in Kristianstad, Sweden. The rehabilitation team that
have carried out this study include the Rehabilitation Dr, Physio, and
Prosthetist. There has been many interesting findings along the course of
this study, all of which have led to the technique being adopted as a
standard in many centres through Scandinavia.
We at Ossur believe this technique aids the formation of well healed, well
shaped residual limb and as a result we are putting considerable efforts
into research in this area.
We have available technical manuals that outline the currently recommended
procedure along with the documented benefits. If you have further questions,
contact me.
Ian Fothergill,
CPO/ Product Manager
Ossur Prosthetics
E-mail: <Email Address Redacted>

I have one experience with this type of situation. A 50 yro male approx. 275#
bilateral TT secondary to trauma from MVA. Scar tissue and skin graft over
the entire RL, lot's of adherent scar tissue. Used FF VSP. Tried every liner
in the book (Tech - both custom and non custom, Dermo and Alpha) with and
without shuttle. Shuttle is a huge mistake, but did it at client's
insistance. Skin break down out the ying yang with every thing we tried and
he really did not walk that much. Huge failure.While this case was alot more
of a problem than yours, you have an up hill battle. If it were me I would
try the following:
a) custom Tech liner
b) suction suspension w/o shuttle - use asuction sleeve of your choice.
c) OWW pathfinder or if weight is concern, use Springlite Luxon Max with very
soft soft heel and toe. I have had good experiences with both these feet.
Good luck. Please let us know how you make out.
Paul

I have been using what I call HCI's for post-amputation/pre-prosthetic
fitting oedema controller and RL maturator. An HCI =
Hypobaric-Compliant/Compression-Interface. I have used it on all
daignoses - including brittle diabetics, and post necrotizing fasciaitis in
which the patients RL was 90% skin graft. The only contraindications might
be if the patient could not donn the HCI. Wearing protocol involved
progressively increasing wearing time to most of the waking hours.
-Hope this helps - Jan