Bilateral Silicone Symes Summary

Bilateral Silicone Symes Summary

Paul Prusakowski

12/19/2001

Dear list,

Here is the summary of responses that I have received regarding the
fabrication of a pair of bilateral Symes prostheses for a patient with
extensive upper limb involvement. Due to other medical problems the
person is experiencing, the next steps of fabrication have been delayed.
Regardless, here is the original question and the summary of responses.
Thanks.

Paul Prusakowski, CPO
O&P Clinical Technologies
Gainesville, FL

Original question:

I am working with an individual with bilateral symes amputations. She
has extremely limited use of her hands, so she cannot utilize any sort
of windows or straps. She has been very successful with wearing
prostheses with hard sockets and a single thick sock. Suspension is a
combination of supramalleolar suspension, suction, and friction. The
sockets she has been wearing on her old prostheses have a section of
silicone lamination on the inside of the socket (not an expandable wall-
just a more tacky section of socket wall within the socket) to help
provide a higher level of grip once she pushes her residual limbs into
the prostheses. She has been very pleased with this system, and is
requesting that the pair that I am fabricating for her now includes this
feature. I would like to have a Central Fabrication facility perform
this lamination for me, and am wondering if any of you have had any
experience working with any C-Fab on a project like this. I don't want
this to be an experiment for some C-Fab, and would prefer to work with
someone who has successfully done these in the past.



Responses:

Hi, I am not sure if you are familiar with a version of the expandable
wall socket. I believe it was developed by Richard Voner in Downey. It
is a thin wall inner socket laminated with flexible resin. An area is
cut out of the socket where you want to suspend. In this cutout, you
sew, yes sew, a piece of elastic stocking, similar to compressogrip.
The this is attached into a cylindrical socket that matches the contours
proximally, very similar to expandable wall silicone. The advantages of
this is weight, ease of don, and ease of doff. Almost no grip motion is
needed.
I have modified this by the use of 1/8 neoprene. You may have to
experiment a bit to find out the proper amount of tension. I usually
use duct tape and a clear cylindrical socket for this. The duct tape
usually lasts about 4-5 donnings and doffs, before it comes apart.

Try Fillauer C-fab. Call and talk to them first but I believe they made
one for me several years ago.

Tony van der Waarde (Canada) has immense experience with silicone
inclusions in all kinds of sockets (pelvic sockets, hemi pelvectomies
etc.). He started this when silicones became available - as far as my
overview of the market goes he seems to be one of the most experienced
ones in silicone applications of this kind. I am convinced he would do
this for you.
You may want to write to <Email Address Redacted>

I would recommend Dave Kiczek very highly. He has always done an
excellent job and has no qualms calling for clarification or with
suggestions. I have the number at work. I should have it memorized by
now, but don't want to steer you wrong.

Paul, Bill Daniel works for me in our c-fab (Orthotics & Prosthetics
Fabrication in Orlando) he has done this type of lamination many times.
He
was the head for SPS C-Fab for many years (when it was a good c-fab)
call me
if you need help or call Bill @ 866-649-3500 or 407-649-7777 Jan
Saunders

Try Bill Sandberg, if anyone has the experience it is him (800)
443-1827. And if he is not familiar with this type of job he will be
honest. I use him for all my difficult/unusual stuff (wood,
leather,...).

Contact Russ Marcotte, CPO who runs Future Fabrications Inc. @
888-947-1225. He's got about 30 yrs. experience. His shop is in
Dawsonville, Georgia.