Alpha liner problem: RESPONSES

Alpha liner problem: RESPONSES

Paul Rieth

9/2/2003

Thanks to all who replied. Below is the initial inquiry, followed by
the responses:

 I could use some input on this situation:
> I am seeing an amputee who has a long, mature AKA with a normal
shape,
> with no unusual crevices or contours. I'm using a lanyard system
with
> the exit through the lateral/distal wall of the socket and frame.
I'm
> having problems with gel cracking/splitting (~5mm) on the medial
seam,
> at the junction of the umbrella attachment. This, in turn, leads to
air
> wicking through the fabric, creating a pocket of air in the liner.
Type
> of liner: I've used 3mm Original and Spirit locking Alpha liners.
The
> liner size is appropriate.
>
> My guess is the side-pulling of the liner is causing the problem,
but
> I've done these previously without this problem. Thinking pistoning
and
> lack of distal contact may be the problem, I've tried gel endcaps,
and
> distal pelite pads to no avail. The socket fits well.

RESPONSES:

- -whenever I have a problem with any Alpha/OWW products I call
Raymond Francis, their staff prosthetist, and run things by him. He
usually
has one or more helpful suggestions that you haven't already tried.
Have
you tried using a medial opening to pull the lanyard thru since the
limb is
fleshier there? Maybe the difference in tissue firmness is pulling the
gel
away from the umbrella when pulling laterally?

--This will not help with this socket but next time you may give this a
try.
To get the lanyard at the very distal end of the socket try adding a
piece
of 5mm Pelite to your lay up to create a void. Start with your plaster
cast
and a PVA bag. Next add a couple of layers of nyglass or perlon and
some
carbon or fiberglass just over the distal end. Cut a piece of 5mm
Pelite a
little wider that your lanyard cord. I like to make the lanyard cord
from 1
inch Dacron stitched with Velcro. The Pelite should be wide enough that
the
lanyard can push through easy and long enough to come out the lateral
side,
about 1.25 x 3 inches. Place the Pelite on the distal end of the mold
running it up the lateral side. Stretch a nyglass over the model and
Pelite
to hold it in place. Now finish your lay up with the three prong
adapter's
no-prong-side facing the lateral side. After you have laminated and
removed
the plaster, use a dremel tool to expose the Pelite on the lateral side
of
the socket without sanding through to the inside and remove it with an
awl.
Using the dremel tool, trim a hole in the inside distal end of the
socket.
For the 1-inch Dacron I trim the hole oblong, .25 x 1.25 inch with the
1.25
running AP. When you are finished the 1-inch strap will feed into the
oblong
hole in the very distal end of the socket and come out the lateral
side. I
like to run the strap to a chafe and Velcro it back to itself.

--I unfortunately have stopped using Alpha liners. Within the last year
I
started having a lot of problems with the gel separating distally (many
locations).
I have followed OWW instructions religiously. I think their might be a

problem with the product.

--The main problem with this situation is that you're using an Alpha
Liner.
The material doesn't provide the characteristics needed to be used in
socket
environment. Urethane or silicone are much better material choices.
The
breakdown you're experiencing in this situation is most likely caused
by
material fatigue. With the lanyard locking the distal end of the liner
and
the pistoning that occurs with those or any pin attachments. The
material
is constantly stretched in that area and eventually fails.

--I have used Alpha liners a lot and there a few reason why they crack
and some
are very simple. The patient is drying then inside out on the stand or

leaving them inside out when not using them, the femur or rough skin is
shaving the
gel away, the lanyard hole is not center. I usually would not use 3 mm
alpha
liners if I used a liner this thin I would use the Iceross transfemoral
liner
it is much more durable, try the 6 or even the 9mm next time, the 9 mm
works
amazingly well even with the thickness.

--maybe try an ossur distal end cup, they come in several sizes and
thicknesses.

--Quit using the Alpha liners and try Otto Bock's 6Y70's or
EuroInternational's liners.

--I believe you are correct in that the lateral pull is causing your
problem.
Ideally the lanyard should pull directly distal to the limb and liner.
You
can get away with the method you use for a variety of reasons: 1) Low
activity
of patient 2) good anatomical suspension 3) shape of distal end of
residual
limb.

I created an adapter to allow for distal pull for the lanyard. It is
very
easy to fabricate and allows you to switch from lanyard to pin to valve
suction
without changing the socket. It does require clearance 1-1/2. I
like to
exit the lanyard anteriorly because it is much easier to don and doff.
The
4SN1(Four Systems in One) allows for exit on all sides. For long AK's
you can
laminate a piece of pelite sandwiched that creates a channel for your
lanyard.
The hole or slot is distal and exits on the side of the socket.

-- I'm sure this has crossed your mind, but your description of the
problem
sounds like the patient is drying his/her liners inside out.

And finally, I will attempt to describe the last idea from an email I
received (and later lost) from an amputee who had the above noted
problem: He suggested donning an ankle-high nylon prior to donning the
Alpha. ( Available from any drug store, Wal-mart, etc...) He stated he
had the above noted problem, but since using the nylons, the problem has
thus resolved.