responses- vass, how soon?

responses- vass, how soon?

zach harvey

8/29/2006

Thanks to all who responded. The vass harmony system has been

 shown to help control volume fluctuation and improve vascular

 supply to the residual limb. For those convinced that vacuum

 sockets are an ideal socket environment, my question addressed

 the right time to go into the system. Your input will help

with a research project I’ll be involved with.

Thanks again, Zach Harvey, CPO

-------------------------

 

Via telephone conversation with Gary Hooks from Ottobock who’s

 very much experienced in fitting the vass harmony and teaching

 the vass course, how quickly to put someone into this system

depends on the cognitive status of the patient as vacuum

 complicates understanding sock ply management. Also, how

frequently the patient will be monitored, the comfort level of

the prosthetist, and the ability to replace the socket with

 > 5 ply fit plays a role. Generally, 3 or more months post

amputation is indicated, although he’s been successful 6 weeks

post with the right patient. He recommends using vacuum

certainly not before the initial post op edema is reduced.


 

Although there is some indication that increased vacuum will

improve wound perfusion and accelerate the healing process, I have found that high

vacuum is contraindicated in new (0-4 mo. post-op) patients. It can be

difficult to manage a total contact fit when the amputee is experiencing rapid stump

atrophy unless they are seen frequently in the office or are very

skilled at looking after themselves. Generally, the possible benefits of high

vacuum outweight the potential negatives. I fit most of my new amps with an

air expulsion valve (like the old TEC valves, available at your local

aquarium store) and a sealing sleeve. This gives them the benefits of zero

pistoning but without the increased potential for negative consequences resulting

from high vacuum.

Marku Saufferer, C.P.(c)
     

  Dear Zach
   
  I suggest to use a strap suspension, for PTB prosthesis especially for TTamputees.
  It does not suffocate the skin from air,and many more advantages.
   
    Please post your results. I just completed the Harmony system (I took the course 6 years ago and did not think it was ready for my patients).

   
   
   
  I hope you don't find my comments offensive. Clearly from a clinical perspective, I would be delivering/providing harmony systems as soon as the incision line was healed. The problem is Medicare does not allow the Harmony system on a preparatory (may be wrong on that issue).
   
    I understand that the Vacuum system results in more management with additional interim sockets to obtain stabilization within the residual limb. Unfortunately if that is true, getting those sockets paid for is a problem. I know cost is not to interfere with clinical decisions, but the fact of life, if we do not cover our cost, we can go out of business.

   
     Vass is great if you have a stable patient and stump. If patient is not stable good luck trying. Vass folks will recommend it to practically every body. They have the right to do so.
Vass or similar fitting will drive you up the wall and insurance will not keep paying for your experimentation. I on the other hand have found out a resin to make custom liner which is water clear and if the patient shrinks you can build it up still water clear and no need to add socks. In addition no matter how big a hole or rip you have in your liner it can be repaired overnight. To be able to put this new liner will take some time. Hopefully one day I may be able to do it.
 
v.k. sharma
cp(c) bocpo lpt(tx) rpoa(abc)

   

Zach, with good circulation at the residual limb you can move right

into
  
vacuum suspension. We do after temp, and preparatory are complete.


 

 

 
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