Answers: Liners and Adhesions-Part I

Answers: Liners and Adhesions-Part I

Ed Neumann

3/14/2005

Liners and Adhesions -Part I

Question: Have any of you successfully used liners on transtibial patients
who have
had skin adhesions at the distal end of the tibia? What kinds of liners and
suspensions did you use (pin lock, sleeve, suction)? How many of you view
skin adhesions as a contraindication to liners and instead use Pelite or
other socket inserts and socks? Thanks! - Ed Neumann, PhD, PE, CP

Responses:

have had goodsuccess by adding a little A&D ointment over the adhesion site
to decrease the pulling of the liner material.

Try evolution liners for info call 888 818 6777

We have successfully used OWW alpha locking liners
with pin suspension on multiple patients with bony adhesions. The flow of
gel liners and their ability to absorb or dampen shear forces are actually
considered an indication for their use.

I have had success using silicone gel liners where adhesions, burn
scarring, etc. were present. The worst problems presented when wounds were
not completely healed and when there were hygiene compromises whether or
not the area in question was well-healed. I found that perspiration
potential related to or unrelated to duration of wear affected skin
integrity. Interestingly, my most successful patients are those who wear
the prosthesis 12-16 hours per day, have a high level of function, and who
have impeccable hygiene practices, i.e.; keeps skin clean, keeps liners
clean, rotates liners, and removes prosthesis several times a day to remove
moisture from skin. Liners that performed best in my Southeastern U.S.
climate were the Iceross Comfort with Sensil and the Iceross Comfort Plus.
I have found that the trade off of silicone suction for pelite or hard
sockets resulted in increased problems due to reduction in surface tension
and traditional problems related to suspension loss.

battled with a patient with distal adhesions and skin invaginations at
the very bottom of the limb. We were unsuccessful at fitting him with
the pin and silicone liner. I didn't try any other types of materials.
We ended up fitting him with socks, hard socket and a distal RTV pad.
We see him about every 2 years now and he is doing great. I have made
other applications work with liners, some just put a bit of Vaseline on
the area and that takes care of the pull.

Yes I have and continue to use liners: pin lock, and sleeve on such cases,
with no ill effects.

I would prefer gel liners, especially with skin adhesions. Sometimes I use
silipos single gel liners and an ultimate gel liner on top. The silipos is
even more forgiving and has mineral oil in it. The Ultimate maintains it's
integrity better than materials like the Alpha liner. This way I get maximum
shear reduction and pressure distribution.

Sometimes I also use Silopad body discs and Silipos distal end pads.
By the way, DAW imports a material called Everflex from Proteor that I think
is better than Pelite. I wouldn't use a pin suspension because you don't
want the chance of distal
milking with the fragile skin that you see with adhesions

For adhesions, the BEST course is using Ossur DERMO liners and suction
suspension with an Alps EASY SLEEVE.

I have had experience with this condition recently, and we successfully
created two different styles of prosthesis in one single prosthesis. We
used the TSS vacculink system from Jim Smith Sales for vacuum compression
of the residual limb to limit migration and friction inside of the socket.
This particular patient had two skin grafts on the distal end of the limb
that were notirritated using this system. The patient is very active and
the sleeve requirement for this system somewhat limited his ability to
participate in sports such as volleyball or basketball. Many efforts have
been made recently to create a sleeve that will tolerate the friction of
the proximal termination point of the socket. I know that Ossur has a
product that has not been released for sale yet although it is inthe
product testing stage. Most sleeves will only last a marginal period of
time before developing a pin hole and losing the seal. I have found that
using the Ohio Willow Wood G-Lock, which combinessuction seal and locking
mechanism application,is appropriate on my very active patients. This gives
these active patients a much needed sense of security. It is necessary to
seal the locking mechanism using silicone sealant or bulk silicone around
the edges. The limb adhesions would be well taken care of in a polyurethane
liner asopposed to thesilicone style of liner,two alternatives are:Alpha
locking liners or Speak with Otto Bock's TEC liner division regarding their
non-friction liners and sleeve, or the TEC harmony system. For further
irritation problems, we have utilized a sillipos distal roll on for
temperature control on the distal end. It is possible to cast directly over
the roll on with the gel liner over the top of it.


Edward S. Neumann, PhD, PE, CP
Professor of Civil and Environmental Engineering
Director, Center for Disability and Applied Biomechanics
Adjunct Professor of Biomedical Engineering
Box 454015
University of Nevada, Las Vegas
Las Vegas, NV 89154-4015
PH: 702 895 1072
FAX 702 895 3936