Details on the Warren flip from John Warren
Benveniste, David Mark
Description
Collection
Title:
Details on the Warren flip from John Warren
Creator:
Benveniste, David Mark
Date:
3/13/2007
Text:
I am forwarding this e-mail on behalf of John Warren CP
Mark Benveniste RN BS CP
MEDVA Medical Center
Houston, TX
USA
Dear List Members,
I've received a ton of response concerning this method of AK suspension.
Mark Benveniste's email was very flattering. I view this technique as
another tool in the bag. It doesn't work for everyone, but can be a
really nice option for some. The system allows for volume changes and
the use of vacuum or suction. Also, I have to say that I can't get any
of the prosthetists that I work with to call it the Warren Flip, we
just call it the flip down, but I've gotten too hung up on labels.
Basically a cushion liner is rolled on to the limb and then the
reflected portion will form a seal on the inside of the socket. The
patient pulls themselves in with a nylon donning bag. Inserts a valve
and or applies vacuum.
Now for some detail, the rolled edge of the liner is left about 1.5-2
distal to the IT and as far down the limb as it will reasonably go.
I've seen as little as 3 and as much as 8 of reflected gel. I
generally hand cast, but I've done CAD sockets as well. Reduction
valves are from 3-4% in the proximal 1/3 and gradually decreasing the
reduction as I move distally. I fit a clear check socket. The seal is
thoroughly evaluated. Sitting is usually the most difficult position to
maintain the seal. I feel pretty good about the seal once the pt can
move through any ROM and sit relaxed with me flexing their hip and
pulling on the socket without any loss of vacuum or suspension. Most
patients have a great seal when they can sit in their car for prolonged
amounts of time.
As far as liners go, I've stuck with liners with thin proximal edges and
fabric covers. I'm always concerned about the transition where the
reflected liner meets skin and socket. Some patients have had welts
develop here. None of the welts have blistered or become problematic.
Usually they form and go away over night. They may or may not return.
So far none have been chronic only episodic.
As far as vacuum goes, I typically use a hand pump/ brake bleeder, but
any method could be used. If the system used is not integrated into the
prosthesis, like a Harmony pump, eVac or Vacu-link, then expect to
recharge the vacuum about every 4-6 hours to maintain vacuum of 10 Hg
or higher.
Sockets design, there really isn't a reason that any design could be
used as long as the seal maintains. I fit IC or MAS (ish) and sometimes
narrow ML ischial bearing but not contained. Some issues have arisen
from sharp contours. These have been resolved by mellowing out the
contour.
If you choose to give it a try, please let me know how it goes. If you
hit a wall, send me an email and I'll see what I can do. Trust me this
is very much an evolving method.
Respectfully,
John Warren CP
Mark Benveniste RN BS CP
MEDVA Medical Center
Houston, TX
USA
Dear List Members,
I've received a ton of response concerning this method of AK suspension.
Mark Benveniste's email was very flattering. I view this technique as
another tool in the bag. It doesn't work for everyone, but can be a
really nice option for some. The system allows for volume changes and
the use of vacuum or suction. Also, I have to say that I can't get any
of the prosthetists that I work with to call it the Warren Flip, we
just call it the flip down, but I've gotten too hung up on labels.
Basically a cushion liner is rolled on to the limb and then the
reflected portion will form a seal on the inside of the socket. The
patient pulls themselves in with a nylon donning bag. Inserts a valve
and or applies vacuum.
Now for some detail, the rolled edge of the liner is left about 1.5-2
distal to the IT and as far down the limb as it will reasonably go.
I've seen as little as 3 and as much as 8 of reflected gel. I
generally hand cast, but I've done CAD sockets as well. Reduction
valves are from 3-4% in the proximal 1/3 and gradually decreasing the
reduction as I move distally. I fit a clear check socket. The seal is
thoroughly evaluated. Sitting is usually the most difficult position to
maintain the seal. I feel pretty good about the seal once the pt can
move through any ROM and sit relaxed with me flexing their hip and
pulling on the socket without any loss of vacuum or suspension. Most
patients have a great seal when they can sit in their car for prolonged
amounts of time.
As far as liners go, I've stuck with liners with thin proximal edges and
fabric covers. I'm always concerned about the transition where the
reflected liner meets skin and socket. Some patients have had welts
develop here. None of the welts have blistered or become problematic.
Usually they form and go away over night. They may or may not return.
So far none have been chronic only episodic.
As far as vacuum goes, I typically use a hand pump/ brake bleeder, but
any method could be used. If the system used is not integrated into the
prosthesis, like a Harmony pump, eVac or Vacu-link, then expect to
recharge the vacuum about every 4-6 hours to maintain vacuum of 10 Hg
or higher.
Sockets design, there really isn't a reason that any design could be
used as long as the seal maintains. I fit IC or MAS (ish) and sometimes
narrow ML ischial bearing but not contained. Some issues have arisen
from sharp contours. These have been resolved by mellowing out the
contour.
If you choose to give it a try, please let me know how it goes. If you
hit a wall, send me an email and I'll see what I can do. Trust me this
is very much an evolving method.
Respectfully,
John Warren CP
Citation
Benveniste, David Mark, “Details on the Warren flip from John Warren,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/227957.
