Is a warm weather a contraindication for the use of liners in belowknee/above knee prosthetics

Is a warm weather a contraindication for the use of liners in belowknee/above knee prosthetics

Shqad Khattak

8/3/2006

Dear All,
 
          I am putting forward a new topic for discussion at our forum.I
will also putforward the letter of my colleaque who is strongly against
the use of liners in Gulf states weather conditions although most of us
spend most of the time here working in the central air-conditioners.The
poor labourers who get amputated due to trauma are either departed to
their home-country or given some office job.I need expert opinions
regarding the reasons mentioned in the letter below.
Opinion of Mr.Azhar Hussain Bhatti ( CPO Dynamic Rehab-Sharjah , U.A.E)
I am dealing with amputee patients from the last 6 years. Till now i
have delivered more than 30 Below Knee Prosthesis. I will share my
personal experience with you regarding your patient. As you know we are
working in a very hot area (Gulf).One should be very careful in
selecting components for amputees and especially in this area where the
weather conditions should be considered as first priority. In fact there
are no special indications or contra indications for any type of
prosthesis. Silicone liner offers optimum comfort. This is why it is
very common in Europe now adays.Unfortunately in Gulf area because of
high sweating, the stump skin becomes very sensitive .The sweat also
decreases the friction between the stump and liner which is the most
important factor in silicone prosthesis. This creates a pumping movement
which creates rubbing of skin and other unpleasant situation for the
patients. Some of them get infections,allergies and other skin diseases.
Till now i have got nearly 10 patients who were happy with liner when
they were abroad (in States or Europe) but got big problems when they
came to Gulf. I have also observed that once a patient has got silicone
prosthesis, the stump becomes so sensitive that they can not tolerate
tepe foam liners. To solve this problem i am making a sandwich type of
tepe foam liner (very soft) in the beginning to let the patient adapt to
it. After 3-4 months the stump becomes normal and it can take some
pressure so i am changing it with normal tepe foam liner. There is no
doubt that the stump muscles become very strong in tepe foam liner and
it can take maximum pressure which is not the case in silicone liner.
To help the amputees in Gulf area, fit them with the most optimum
prosthesis and to avoid future problems for them, i have the following
suggestions.
-Active outdoor walkers even if they are diabetic should be given tepe
foam soft liner instead of silicone liner.
-All those patients who are very open to dust ,dirt, chemicals or can
not maintain the hygienic conditions should not be treated with silicone
liner.Tepe foam liner with suspension knee cap is the best option for
them.
-poor patients who are always exposed to all types of risks will get the
liners spoil very easily and all of us know that liners are very
expensive.
-For indoor walkers with diabetic liners can be used .Here I must say
that Polyurethane liners are better than silicone liners.
I don't know the whole details of your patient but if he is an active
patient according to the age you mentioned I think he is the best
candidate for tepe foal liner. Silicone prosthesis will make a lot of
problems for him in future. Because of the comfort I am sure he will be
happy in the beginning as he will be walking only in A/C room in trial
time but the the real problems will start when he will start his normal
activities.
Waiting eagerly for the experts opinions,
Regards,
Shabina (Orthopaedic Meisterin Germany,CPO)
Dubai---U.A.E