Replies AK fitting
PAUL EDMAN
Description
Collection
Title:
Replies AK fitting
Creator:
PAUL EDMAN
Date:
9/23/2005
Text:
Thanks to all who responded. I should clarify that the graft is not being
used per se. He had a graft which became occluded and after the amputation
the graft was sewn shut. The graft has no real impact on circulation and
no, the surgeon doesn't want it out. I am thinking the leather or the poly
shield. original post at end. thanks again. paul edman
---------------
How about old school leather socket and external knee joints. The opening is
laced, and assuming the troublesome area is at the front, the tongue of the
socket provides some soft padding.
Have a patient with metal fixators in the femur and quite superficial. This
is the only socket that works for him.
---------------------
maybe try a custom liner with a soft gel around the graf area. i know otto
bock does stuff like that. call to inquire
--------------------
Hi Paul,
Similar situation although my patient had a synthetic graft. Quite palpable
after postop shrinking diminished. Reminded me of a small diameter garden
hose. Intolerable pain with donning of the liner.
Took a thin plaster cast over the entire area, about 12L x6 W. Pulled the
thinnest polyethylene shield we could. Figured I used poly for years in
suction sockets and it was the least amount of coefficient of friction on
the area. Following OWW instuctions, I heated a cushion gel liner, pulled it
over the poly and left it overnight. Poly was scived as thin as possible.
Patient places the poly right on the thigh. The graft now had no shear
forces when the liner was donned. It also glides during ambulation. The poly
edge blends into the liner so there is no ridge. I used a 6mm anterior for
durability. Alps silicone oil was provided in case it irritated a specific
area but the patient denies requiring any. This individual in NOT a great
ambulator and truly is not giving it a workout. Fit them in a Marlo Ortiz
socket with a Knit Rite Power Belt suspension. Hope this gives you some
ideas. Patient has been wearing this for about 1 1/2 years
-----------------------
Paul,
If the graft is that prominent and painful you might want to consider a
custom cushion liner or urethane line with built in relief and translate
that to the socket when casting over it. If the patient is experiencing so
much pressure you might need to off load him using a corset and joints if
the pressure is translated distally. The third option is to have the surgeon
examine the graft on x-ray or scan and see if there might be a problem with
the tissue or the graft itself if its that painful
------------------------
Paul, I had a similar case several years ago, the graft was actually a
shunt used for dialysis and was quite firm. In speaking with the surgeon he
was adamant that pressure over the shunt could cause collapse with loss of
any access for dialysis... We elected to not provide a prosthesis as
surgical movement of the shunt was also not an option for this patient.
Pain is your friend. If light to moderate pressure over the graft is
painful, there is a good possibility that use of an AK prosthesis could
cause damage to the graft or surrounding tissues and could potentially
compromise primary circulation to the residual limb. Talk with the surgeon
and explain your dilemma, if they are not willing to discuss, let your
patient know that provision of prosthesis will most likely not be possible
with his current pain situation. Good luck
---------------------
HAVE ENCOUNTERED SIMILAR PROBLEMS. MY SUGGESTION WILL BE TO MAKE SURE THAT
HE IS NOT CARRYING INFECTION. ONLY A PHYSICIAN MOST LIKELY HIS OWN WILL
CLARIFY THAT. INVARIABLY WHEN I ENCOUNTERED THERE WERE FEVERLESS INFECTIONS
WHICH DO NOT CAUSE FEVER BUT PAIN IS INDESCRIBABLE
--------------------------
Paul, the first question I have is regarding the socket shape in relation to
the graft site. If it is anterior and medial why not an exagertated Narrow M-
L design with no compression in the anterior fossa. I would do everything I
could to contour the socket and compress the tissues away from the graft
site. Please post your responses
---------------------------
Paul...I would suggest you send him to his physician immediatly. There may
be some intrinsic problem with his graph.
-------------------------------
-------------------------------
Interesting case for everyone. Would appreciate any suggestions. A
> collegue of mine sees a recent TF amputee. This gentleman previously
> underwent a fem-ant tib bypass with a composite graft. Subsuquent
occlusion
> required a TFA. He was fit with a Ossur Seal In tf liner. Did great for a
> couple of weeks in rehab. His limb shrunk and the graft became quite
> superficial and easily palpable. Now even donning the liner is torture.
> The liner was ditched and a sock fit with a belt was tried but provided no
> significant relief. Any suggestions to keep pressure (which I assume
causes
> the pain) off the graft. Socket reliefs alone have not cut it so far. paul
> edman cp
--
Altru Health System ( <URL Redacted>)
used per se. He had a graft which became occluded and after the amputation
the graft was sewn shut. The graft has no real impact on circulation and
no, the surgeon doesn't want it out. I am thinking the leather or the poly
shield. original post at end. thanks again. paul edman
---------------
How about old school leather socket and external knee joints. The opening is
laced, and assuming the troublesome area is at the front, the tongue of the
socket provides some soft padding.
Have a patient with metal fixators in the femur and quite superficial. This
is the only socket that works for him.
---------------------
maybe try a custom liner with a soft gel around the graf area. i know otto
bock does stuff like that. call to inquire
--------------------
Hi Paul,
Similar situation although my patient had a synthetic graft. Quite palpable
after postop shrinking diminished. Reminded me of a small diameter garden
hose. Intolerable pain with donning of the liner.
Took a thin plaster cast over the entire area, about 12L x6 W. Pulled the
thinnest polyethylene shield we could. Figured I used poly for years in
suction sockets and it was the least amount of coefficient of friction on
the area. Following OWW instuctions, I heated a cushion gel liner, pulled it
over the poly and left it overnight. Poly was scived as thin as possible.
Patient places the poly right on the thigh. The graft now had no shear
forces when the liner was donned. It also glides during ambulation. The poly
edge blends into the liner so there is no ridge. I used a 6mm anterior for
durability. Alps silicone oil was provided in case it irritated a specific
area but the patient denies requiring any. This individual in NOT a great
ambulator and truly is not giving it a workout. Fit them in a Marlo Ortiz
socket with a Knit Rite Power Belt suspension. Hope this gives you some
ideas. Patient has been wearing this for about 1 1/2 years
-----------------------
Paul,
If the graft is that prominent and painful you might want to consider a
custom cushion liner or urethane line with built in relief and translate
that to the socket when casting over it. If the patient is experiencing so
much pressure you might need to off load him using a corset and joints if
the pressure is translated distally. The third option is to have the surgeon
examine the graft on x-ray or scan and see if there might be a problem with
the tissue or the graft itself if its that painful
------------------------
Paul, I had a similar case several years ago, the graft was actually a
shunt used for dialysis and was quite firm. In speaking with the surgeon he
was adamant that pressure over the shunt could cause collapse with loss of
any access for dialysis... We elected to not provide a prosthesis as
surgical movement of the shunt was also not an option for this patient.
Pain is your friend. If light to moderate pressure over the graft is
painful, there is a good possibility that use of an AK prosthesis could
cause damage to the graft or surrounding tissues and could potentially
compromise primary circulation to the residual limb. Talk with the surgeon
and explain your dilemma, if they are not willing to discuss, let your
patient know that provision of prosthesis will most likely not be possible
with his current pain situation. Good luck
---------------------
HAVE ENCOUNTERED SIMILAR PROBLEMS. MY SUGGESTION WILL BE TO MAKE SURE THAT
HE IS NOT CARRYING INFECTION. ONLY A PHYSICIAN MOST LIKELY HIS OWN WILL
CLARIFY THAT. INVARIABLY WHEN I ENCOUNTERED THERE WERE FEVERLESS INFECTIONS
WHICH DO NOT CAUSE FEVER BUT PAIN IS INDESCRIBABLE
--------------------------
Paul, the first question I have is regarding the socket shape in relation to
the graft site. If it is anterior and medial why not an exagertated Narrow M-
L design with no compression in the anterior fossa. I would do everything I
could to contour the socket and compress the tissues away from the graft
site. Please post your responses
---------------------------
Paul...I would suggest you send him to his physician immediatly. There may
be some intrinsic problem with his graph.
-------------------------------
-------------------------------
Interesting case for everyone. Would appreciate any suggestions. A
> collegue of mine sees a recent TF amputee. This gentleman previously
> underwent a fem-ant tib bypass with a composite graft. Subsuquent
occlusion
> required a TFA. He was fit with a Ossur Seal In tf liner. Did great for a
> couple of weeks in rehab. His limb shrunk and the graft became quite
> superficial and easily palpable. Now even donning the liner is torture.
> The liner was ditched and a sock fit with a belt was tried but provided no
> significant relief. Any suggestions to keep pressure (which I assume
causes
> the pain) off the graft. Socket reliefs alone have not cut it so far. paul
> edman cp
--
Altru Health System ( <URL Redacted>)
Citation
PAUL EDMAN, “Replies AK fitting,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/225464.
