Suction TF sockets with silicone liners

Suction TF sockets with silicone liners

Paul E. Prusakowski

8/4/2003

Dear list,

I have been dealing with a very challenging case over the last year with an
active patient in her late 60's who has been a transfemoral amputee for most
of her life. She has gone through significant changes in her body shape and
tissue consistency though the years, and we have been struggling with a lot
of soft tissue in the residual limb, especially in the proximal region.

She has a very long residual limb (almost knee disarticulation), with a
challenging distal lateral region, and very soft tissue consistency along
the entire residual limb. She has been wearing suction sockets for most of
her life, and has a history of having a lot of sockets made by
prosthetists in the past, all trying to obtain that elusive fit. She pulls
into her sockets with a Zip-wiz type donning aid, and when she removes her
prosthesis she literally pushes her hand down into the socket and starts
pulling soft tissue out by the hand full. It's as interesting to watch as it
is to describe....

I have done my share of making and remaking suction sockets for her, and
have found that dealing with the soft tissue is a losing battle-- and that
the differences that occur between sitting and standing would require
practically two different sockets to be made to contain her when standing,
as well as allow comfortable sitting.

I have been considering using a silicone liner on her limb to contain and
control the tissue of the residual limb in order to give me something more
firm and controllable to work with. I had an extra large-plus Alpha liner
in the office and tried it on her, and it definitely contained the tissue
and provided a much firmer starting point.

I would like to continue with a suction socket system while using a liner
and have heard of others doing this successfully. I have used some liners
for TF patients with lanyards in the past, and have tried the lateral lock
from Coyote as well, but those are not an option for this patient.

I am interested in hearing any experiences, feedback, suggestions, pitfalls,
etc. about how to move forward with this. What are the best liners to use
in this situation? How do you maintain the suction? (i.e. wet fit a
silicone liner into the socket? Pull in with a pull sock?) What liners
have you tried in the past for this and why would you use/not use them? I
have heard of some people using Alpha Cushion liners and pulling in with a
pull sock, but doesn't the fabric wick air in to lose the suction
suspension? Any differences in socket design?

Thanks for your input. I am looking forward to tackling this challenging
case some day soon.


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