Proximal Liner Rollage - Responses
John T. Brinkmann
Description
Collection
Title:
Proximal Liner Rollage - Responses
Creator:
John T. Brinkmann
Date:
4/23/2004
Text:
List Members,
Here is my original question, with responses. Thanks to all who responded with ideas. I've ordered an Alpha liner and will be fitting that to the patient. The additional stretch seems to allow for better fit proximally. I doubt that this will resolve all of the problems with this case, but it's a start...
John Brinkmann, CPO
I have a patient with a small RL and a very large thigh. A properly fitting liner rolls distally on the thigh due to being too tight in that area. I have trimmed a liner as far distally as I can, and the liner continues to roll. Patient has used an Alpha liner in the past, but had problems that I attributed to too loose of a socket. I changed to a Ossur Dermo liner, which she is currently wearing. Any ideas on how to address this problem?
RESPONSES
*The easiest solution is to add a small (2 to 4 inch) remnant of another liner on top of the proximal edge. We typically use clear silicone gel.
*make a 3-S liner
*Could you use the Iceross subliner on the RL length to reduce the disproportionate circumferences?
*You may want to try to scallop the prox. edge of the liner with scallopping scissors-this will increase the surface area contacting the skin reducing any tourniquette effect that the tight prox. circmfrnc. may casue and it should also allow stretch along the proximal edge. Be aware that the liner may keep rolling. First you might try a band of elastic over the edge of the liner-nothing restricting just an inhibitor
*I have had several TT patients with very large thighs and found that leaving the liner as long as possible worked the best. When I cut them short they always rolled. I pretty much use alpha liners exclusively.
*When an athlete pulls a quad or hamstring a compressive sleeve (neoprene) is used. I suggest a non-allergenic type of thigh wrap applied to the thigh (Velcro, USA make a product in varying thicknesses). You could apply the liner up and over the wrap and I think it would solve your problem.
*Put him back into an alpha plus size liner. The liner can be a large at the bottom and x-tra large up top. If it still needs to be larger up top to prevent rolling, cast the limb and thigh and heat the alpha liner. It will take the shape of the cast. Hope this helps.
*I have had the same predicament and had TEC make a custom Profile liner which worked out well.
*similar problem solved but cutting notches in the liner, little half moons across the whole thing. Notches are better if they are rounded versus triangular. The notches allow the liner to spread open more than when un-notched.
*Try an Explorer liner, they thermoform to the larger thigh and won't roll down as badly.
*You can use one of the ALPs thermoliner that can be formed over the mold.Remember to cast at the thigh level and the liner shouldn't roll down.
*A simple piece of elastic with Velcro ends sized to fit snugly around the thigh about two inches (give or take) below the proximal edge of the sleeve. The sleeve will roll over until it comes to the elastic. The patient usually just flipped over the sleeve on top of the elastic when they first applied the prosthesis instead of waiting for it to roll down.
*Have you tried the alps covered tapered liner I find them great in this situation
*The EXPLORER Mineral Oil Gel Liner will easily stretch to accommodate the thigh that you are talking about. In addition, it will not constrict proximaly or 'rope' and roll down.
*If you don't need a distal pin, Freedom Innovations just introduced the Evolution liner, which is a custom silicone liner with an additive that provides flow characteristics similar to that of urethane. A nice thing about the Evolution is that you get the mold with the first liner, which allows you to easily pour replacement custom liners in your office for
$50 to $100, and deliver them the same day.
---------------------------------
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Here is my original question, with responses. Thanks to all who responded with ideas. I've ordered an Alpha liner and will be fitting that to the patient. The additional stretch seems to allow for better fit proximally. I doubt that this will resolve all of the problems with this case, but it's a start...
John Brinkmann, CPO
I have a patient with a small RL and a very large thigh. A properly fitting liner rolls distally on the thigh due to being too tight in that area. I have trimmed a liner as far distally as I can, and the liner continues to roll. Patient has used an Alpha liner in the past, but had problems that I attributed to too loose of a socket. I changed to a Ossur Dermo liner, which she is currently wearing. Any ideas on how to address this problem?
RESPONSES
*The easiest solution is to add a small (2 to 4 inch) remnant of another liner on top of the proximal edge. We typically use clear silicone gel.
*make a 3-S liner
*Could you use the Iceross subliner on the RL length to reduce the disproportionate circumferences?
*You may want to try to scallop the prox. edge of the liner with scallopping scissors-this will increase the surface area contacting the skin reducing any tourniquette effect that the tight prox. circmfrnc. may casue and it should also allow stretch along the proximal edge. Be aware that the liner may keep rolling. First you might try a band of elastic over the edge of the liner-nothing restricting just an inhibitor
*I have had several TT patients with very large thighs and found that leaving the liner as long as possible worked the best. When I cut them short they always rolled. I pretty much use alpha liners exclusively.
*When an athlete pulls a quad or hamstring a compressive sleeve (neoprene) is used. I suggest a non-allergenic type of thigh wrap applied to the thigh (Velcro, USA make a product in varying thicknesses). You could apply the liner up and over the wrap and I think it would solve your problem.
*Put him back into an alpha plus size liner. The liner can be a large at the bottom and x-tra large up top. If it still needs to be larger up top to prevent rolling, cast the limb and thigh and heat the alpha liner. It will take the shape of the cast. Hope this helps.
*I have had the same predicament and had TEC make a custom Profile liner which worked out well.
*similar problem solved but cutting notches in the liner, little half moons across the whole thing. Notches are better if they are rounded versus triangular. The notches allow the liner to spread open more than when un-notched.
*Try an Explorer liner, they thermoform to the larger thigh and won't roll down as badly.
*You can use one of the ALPs thermoliner that can be formed over the mold.Remember to cast at the thigh level and the liner shouldn't roll down.
*A simple piece of elastic with Velcro ends sized to fit snugly around the thigh about two inches (give or take) below the proximal edge of the sleeve. The sleeve will roll over until it comes to the elastic. The patient usually just flipped over the sleeve on top of the elastic when they first applied the prosthesis instead of waiting for it to roll down.
*Have you tried the alps covered tapered liner I find them great in this situation
*The EXPLORER Mineral Oil Gel Liner will easily stretch to accommodate the thigh that you are talking about. In addition, it will not constrict proximaly or 'rope' and roll down.
*If you don't need a distal pin, Freedom Innovations just introduced the Evolution liner, which is a custom silicone liner with an additive that provides flow characteristics similar to that of urethane. A nice thing about the Evolution is that you get the mold with the first liner, which allows you to easily pour replacement custom liners in your office for
$50 to $100, and deliver them the same day.
---------------------------------
Do you Yahoo!?
Yahoo! Photos: High-quality 4x6 digital prints for 25¢
Citation
John T. Brinkmann, “Proximal Liner Rollage - Responses,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 6, 2024, https://library.drfop.org/items/show/222970.
