Reponses to "Harmony Suction Prosthetists"

Reponses to "Harmony Suction Prosthetists"

Alan Ross, CPO

Original Post:

To Harmony Prosthetists and those wearing the Harmony Suction System:

Several of our patients wearing the Harmony Suction System have reported
significant increases in perspiration accumulation within the Harmony Custom
Elastomeric liners since they began using this system. I have witnessed the amount
of this accumulation and it is significant to say the least. Interestingly,
we were under the impression that the vacuum assist system was supposed to
actually reduce perspiration accumulation, but this has not been our experience,
and in several cases, perspiration accumulation has increased with the use of
this new system. (Beyond this, we have found the comfort and suspension to be
unparalleled.) We have tried modifying the application of the sheath worn
over the liner to terminate proximal to the proximal edge of the custom Harmony
Liner to allow improved wicking of moisture. This has not yielded any
benefit. Otto Bock has recommended that patients try a roll-on antiperspirant by
the name of Certain Dry. Has anyone had similar experiences with increased
perspiration problems that they would care to share? Has anyone experimented
and/or developed any other suggestions that we might try?
Thank you and I will post responses.
Alan Ross, CPO, LPO
Suncoast O & P
Sarasota, FL

Summary: THANKS TO ALL OF YOU KIND PEOPLE WHO RESPONDED! The general
consensus is that there seems to be an increase in perspiration. Comfort and
suspension receive high marks for the most part, but my experiences with increased
perspiration appear to be confirmed by other uses and wearers.

Responses:

Alan,
I have had similar problems as well as great fits and suspension. These are
the just some of the pros and cons. I to have asked a few patients to try
Certain Dri. It has help but not enough patients to draw any conclusions.
I will wait for you posted results.
Thanks for asking.
Erik Tompkins,CP,BOCPO

Alan,
The Harmony System in general is drawing tissue and fluid into the socket
and not expelling to maintain the fit. I've found that with some patients if
the socket is not real snug or if your using prosthetic socks 1 to 3 ply you
will have greater accumulation of fluid. Certain dry does help but only time
seems to have an effect on the amount of perspiration accumulation. This
also seems to true for the Ossur sealing liner and the Alpha suction setup.
The benefits of the vacuum out weigh the moisture for most of my patients.
The key to happy wearers is proper hygiene, if they keep things clean then a
little extra sweat is worth it.
Sweating the days of summer away,
Carey Glass CPO FAAOP

Hello Alan;
I suspect that the persons experiencing significantly increased levels of
perspiration using the Harmony suction system are also endowed with a fair
amount of body hair in the limb region. I have found that having these
people shave their legs helps to dramatically lower perspiration
accumulation related to suction liner use.
Until they shave to remove the excess hair, the suction liner 'bridges' over
each hair strand, in such a way that immediately adjacent to the hair strand
it is not touching the skin. This creates an air space, with lower vapour
pressure than for the areas where the liner does lie tightly against the
skin. There is an accumulation of perspiration into that space until the
vapour pressure rises and reaches an equilibrium across the skin epithelium.
I recommend the use of an electric razor, to prevent accidental razor cuts.
Have them try it, and I think that your patients will experience much less
perspiration.
Geoffrey Hall, B.Sc., C.P. ( c )
Victoria, BC Canada

We have had similar experience with the Harmony. It wouldn't be such a
bummer if we hadn't sold the idea of reduced perspiration. I'm interested
in responses.
Thanks,
Jeff McDonald CP

Alan,
Thanks for this post. I am currently being fitted with a Harmony system
and was hoping for the decrease in perspiration! I have been using Alpha
liners for many years and recently started using the Alps
anti-perspirant spray. That really seems to knock it down quite well
with no ill effects on my skin. Please post your responses as I'm
interested in hearing what others have found.
Thanks and good luck.
Chris
Christopher Phillips, CO


The best product out on the market for sweating is ALUM!! It is an all
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under 'Sweat Control'.
Here is a couple of other links that explain the merits of ALUM;
Article written by prosthetist, Tony van der Waarde, CP(c) - 'Don't
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'All Natural Crystal Body Deodorant' -
<URL Redacted>
'About the Crystal' - Crystalux
http://www.sedonaproducts.com/crystal.htm
Tracy Steer
Clinical Assistant



Dear Alan -
I am a physical therapist as well as a bilateral transtibial amputee. I had a
revision last year and subsequently needed new prostheses. I approached a
local prosthetist with a request for a prosthesis that would accommodate volume
changes as well as control perspiration. He recommended the VASS Harmony
System, which were then fabricated.
Well, you are quite right, Alan - Perspiration is indeed a problem, as is
volume change - I still sink in at the end of the day and, when I remove the
prosthesis at night, there is quite a bit of liquid in the bottom of the liner. I
have been forced to conclude that the system does NOT really control or
accommodate either issue, beyond perhaps some minimal control. I am disappointed, to
say the least, although I will acknowledge that (when it's working
correctly), the suspension is superb.
I would like to try the antiperspirant that you mentioned - I'll let you know
how it works out.
Carol A. Sheredos, PT, MA
Baltimore, MD

Alan,
I am a big fan of VASS. I have been using it from the beginning and have
assisted both TEC and Otto Bock in training practitioners in its use. I am
continually impressed by what VASS offers our patients and have never experienced
the problems that you are describing. To the contrary I have seen a
tremendous decrease in moisture by adding VASS to a urethane/suction socket. It seems
that most patients quantify this in the range of 80-85% reduction. A few
questions... What type of liner/suspension system are you using for a comparison?
Is your liner fitting appropriately? How many sock ply? Is the socket
fitting well? Is there a proper seal? Have you verified vacuum with a gauge? Has
the patient successfully used a urethane liner with a suction seal prior to
adding vacuum? I'd gladly discuss further. Feel free to give me a call at 801
266-7768.
Jim Liston CP FAAOP

Hello Jim:
Thanks for the thoughtful response. Let me begin by saying that I too am a
big fan of VASS. There is no question in my mind that this system has
something remarkable to offer patients. Answers to your questions: We are/have been
using Alpha liners with a pin lock, Ossur Seal-In technology, Alpha Cushion
Liners with valve and suction knee sleeves. Most of these wearers report
perspiration to some degree, but nothing compared to what I have witnessed with
several of our Harmony wearers. The TEC Harmony liners appear to be well fitting,
no gapping and there is a reasonable degree of snugness to the liner.
(Beyond these parameters, how do you quantify a satisfactory fit of the liner?) The
patients involved are not wearing any prosthetic socks as the fit of their
socket does not require it. Attempting to add a sock produces a fit that is
uncomfortably snug for these patients. Suction has been evaluated using the Otto
Bock gauge and found to be in the 23 - 25 mm/Hg range (and holds at that
level over time). I am not quite sure I understand your last question. One
patient (with the most impressive degree of perspiration accumulation) previously
used an Alpha locking system (fabricated elsewhere). He developed significant
socket pistoning, went on to ulcerate the anterior distal tibia and required
surgical intervention. The Harmony system has prevented a recurrence of this
problem, but he is swimming in perspiration. His distal tissue looks like he
has spent two days in a hot tub! Perhaps it is the socket fit, perhaps it is
the liner. I believe that this patient has a satisfactory fit, but I could be
wrong. I will tell you, Jim, that I am getting ready to post the responses
that I have received, and most of them do report increased perspiration
occurrences. I look forward to your thoughts and insight. Thanks again for
responding.
Alan

Alan
this is the sencond time in two weeks where this problem has came up, a
prosthetist in arkansas has as my opinion on the subject it seems when the
pt. was wearing an alpha liner and pin the perperation was not near as bad
as after switching to the harmony system and urethane liner
to which otto bocks answer to this was the socket was not tight enough in
fact a representitive from bock made a new socket for this pt. but the
problem still exist, i will be at the fl. chapter meeting if you would like
to discuss this further, i do have a few theories on this problem
Steve Smith
Director of tech service
Smith global

Thanks again to those who took the time to respond.
Alan