Reponses on Prosthetic Skin
dbeckham
Description
Collection
Title:
Reponses on Prosthetic Skin
Creator:
dbeckham
Date:
5/28/2008
Text:
Members:
Please find below the responses I have received regarding a prosthetic skin
that is durable when used with a dynamic foot and/or heel height adjustable
foot.
I found that DAW works pretty well, if you take a piece of cream cow and
scythe it, and glue it to the ankle overlapping the foot shell and cover
this will take away the pinch point where the skin is tearing.
The most durable skin we have ever used is a custom silicone skin from
Dorset Orthopedic in England. Yes it is expensive but I have patients who
have worn them for 3 years or more, plus they look terrific!
I have had good outcomes with the Steeper skins.
Our Dream skin is very durable and carries a 6 month warranty. Customers
tell me it solves the problem of splitting at the heel with dynamic feet. It
is extra think in that area.
Prosthetic Research Specialists can make you a skin with Achilles area
reinforcement. Call and speak to them. They work for my J-shaped Flex Feet
patients.
Are you beveling the top edge of the foot shell and bonding the cover to
that. If the cover just floats on top of the foot shell then the skin gets
pinched in posterior and tears prematurely. OSSUR makes a flex skin
specifically for their dynamic feet and heel height feet. Not sure what type
you have been using. Also check the shoes that pt is wearing. I assume
female from heel height. Sometime if it is a strap shoe or sandal, the strap
needs to be modified to take off its edgyness to keep it from tearing the
cover. In my experience someone who wears these types of shoes with a skin
for long periods of aggressive use just wears that area out inevitably. I
have used the Skinergy BK skin as it has good stain resistance if markings
are dealt with quickly and it also comes with extra patches that can be use
to repair wear spots. I often add these to the posterior aspect of the
heel/achilles of the skin to give a larger buffer to tearing. Also, save the
unused portion of the skin that you trim off the trim line and do the same
thing I just mentioned with any skin you choose for reinforcement. Best of
luck
I have found great success with PRS skins for my prostheses. When I'm
dealing with adjustable or very flexible feet I'll sometimes ask for a
custom skin where they reinforce wear points. The other option would be to
use an Otto Bock skin and reinforce the heel and forefoot by using a thin
spectra sock. This seems to work when the patient is very active. One of the
problems with patients who keep tearing their prosthetic skins is how they
take care of them. Be sure they are wearing socks or stocking when putting
on shoes. If they are beach goers then sand and sun exposure effects the
skins durability. Un fortunately none are full proof and most patients tear
their skins within six months a to a year.
Skinergy rep informed me two weeks ago they now have a lay-up with Kevlar. I
had used them previously because the patients loved the cosmesis of the
Skinergy. However, I ran into the same problems you discussed. The skin does
still have adequate stretch and multidirectional give to not impede motion.
Caveat! Try one on your most difficult patient first. I love working with a
manufacturer that listens to a clinician's complaints and corrects the
problem. This is what Skinergy did for us, on the drawing board! Would
forewarn the patient. I work with Robin James up at Liberating Technology,
Inc who distributes them.. Great time of the year activity wise to give
this latest version a chance. If this does work for your patient, it would
be great if you would let everyone know. Thanks for the networking. Good
luck.
One of the biggest problems that most skins have is a lack of stretch. When
you place weight on a limb. It forces the footshell to become an immovable
object. The patient moves back and forth and the skin can't stretch as far
as the components can, soon the foam tears at the top of the footshell
because it moves further than the footshell does. Our skin products if
installed correctly, can take the stretch much further than the foam can. To
do a skin properly on someone with an energy storing type foot and shin, you
must cut the footshell down to the floor under the malleolus on each side.
Cut the heel down to just above the point that locks the back of the foot in
and cut the front down about an inch. Cut all edges down and sand them to
about a 45 degree angle to allow more bonding area when you glue to foam to
the footshell. After you shape the limb, articulate the foot and watch to
see the foam actually moving with the footshell as it flexes. Our spray skin
can then be applied directly to the limb and it stretches further than the
foam or footshell.
Please let us know if we can help you in any way. If needed, I can travel to
your facility to teach these methods so your techs can reproduce it each
time.
You might try the Fillauer Dream skin. It seems very durable. We have just
started using it.
Please post responses. I am going to guess that the cover splits at the
ankle usually when you are using a flex foot. The footshell they use has a
sharp edge at the top of the heel. We get tears right there all the time,
when we use the Skinergy sleeve, which is still our favorite skin at this
point in time.
With every single user adjustable height foot model we have used, the skin
has failed within 8 months. I think the issue is that once the patient
leaves our office they forget the donning and doffing procedure taught to
them in or office. With more patient adjustable features the likelihood of
skin wear and tear go up two-fold. To answer your question, THERE ARE NONE.
If you come across any let me know. I have used the Bock Skin, Skinergy,
Dreamskin, PRS, DAW, just to name a few. I find that with adjustable
setting the patient is better to go with the traditional cover with stocking
cosmesis. Sorry I could not be more of assistance.
I am currently using a fillaur skin with exact same situation. So far so
good.
The only skin I have found to be durable is the Dawskin. I know the company
really is awful to deal with because of the non stop sales calls..but the
skin is great.
Sincerely,
Dale Beckham, CPA, LOPA
Director of Operations
Prosthetic-Orthotic Associates
Please find below the responses I have received regarding a prosthetic skin
that is durable when used with a dynamic foot and/or heel height adjustable
foot.
I found that DAW works pretty well, if you take a piece of cream cow and
scythe it, and glue it to the ankle overlapping the foot shell and cover
this will take away the pinch point where the skin is tearing.
The most durable skin we have ever used is a custom silicone skin from
Dorset Orthopedic in England. Yes it is expensive but I have patients who
have worn them for 3 years or more, plus they look terrific!
I have had good outcomes with the Steeper skins.
Our Dream skin is very durable and carries a 6 month warranty. Customers
tell me it solves the problem of splitting at the heel with dynamic feet. It
is extra think in that area.
Prosthetic Research Specialists can make you a skin with Achilles area
reinforcement. Call and speak to them. They work for my J-shaped Flex Feet
patients.
Are you beveling the top edge of the foot shell and bonding the cover to
that. If the cover just floats on top of the foot shell then the skin gets
pinched in posterior and tears prematurely. OSSUR makes a flex skin
specifically for their dynamic feet and heel height feet. Not sure what type
you have been using. Also check the shoes that pt is wearing. I assume
female from heel height. Sometime if it is a strap shoe or sandal, the strap
needs to be modified to take off its edgyness to keep it from tearing the
cover. In my experience someone who wears these types of shoes with a skin
for long periods of aggressive use just wears that area out inevitably. I
have used the Skinergy BK skin as it has good stain resistance if markings
are dealt with quickly and it also comes with extra patches that can be use
to repair wear spots. I often add these to the posterior aspect of the
heel/achilles of the skin to give a larger buffer to tearing. Also, save the
unused portion of the skin that you trim off the trim line and do the same
thing I just mentioned with any skin you choose for reinforcement. Best of
luck
I have found great success with PRS skins for my prostheses. When I'm
dealing with adjustable or very flexible feet I'll sometimes ask for a
custom skin where they reinforce wear points. The other option would be to
use an Otto Bock skin and reinforce the heel and forefoot by using a thin
spectra sock. This seems to work when the patient is very active. One of the
problems with patients who keep tearing their prosthetic skins is how they
take care of them. Be sure they are wearing socks or stocking when putting
on shoes. If they are beach goers then sand and sun exposure effects the
skins durability. Un fortunately none are full proof and most patients tear
their skins within six months a to a year.
Skinergy rep informed me two weeks ago they now have a lay-up with Kevlar. I
had used them previously because the patients loved the cosmesis of the
Skinergy. However, I ran into the same problems you discussed. The skin does
still have adequate stretch and multidirectional give to not impede motion.
Caveat! Try one on your most difficult patient first. I love working with a
manufacturer that listens to a clinician's complaints and corrects the
problem. This is what Skinergy did for us, on the drawing board! Would
forewarn the patient. I work with Robin James up at Liberating Technology,
Inc who distributes them.. Great time of the year activity wise to give
this latest version a chance. If this does work for your patient, it would
be great if you would let everyone know. Thanks for the networking. Good
luck.
One of the biggest problems that most skins have is a lack of stretch. When
you place weight on a limb. It forces the footshell to become an immovable
object. The patient moves back and forth and the skin can't stretch as far
as the components can, soon the foam tears at the top of the footshell
because it moves further than the footshell does. Our skin products if
installed correctly, can take the stretch much further than the foam can. To
do a skin properly on someone with an energy storing type foot and shin, you
must cut the footshell down to the floor under the malleolus on each side.
Cut the heel down to just above the point that locks the back of the foot in
and cut the front down about an inch. Cut all edges down and sand them to
about a 45 degree angle to allow more bonding area when you glue to foam to
the footshell. After you shape the limb, articulate the foot and watch to
see the foam actually moving with the footshell as it flexes. Our spray skin
can then be applied directly to the limb and it stretches further than the
foam or footshell.
Please let us know if we can help you in any way. If needed, I can travel to
your facility to teach these methods so your techs can reproduce it each
time.
You might try the Fillauer Dream skin. It seems very durable. We have just
started using it.
Please post responses. I am going to guess that the cover splits at the
ankle usually when you are using a flex foot. The footshell they use has a
sharp edge at the top of the heel. We get tears right there all the time,
when we use the Skinergy sleeve, which is still our favorite skin at this
point in time.
With every single user adjustable height foot model we have used, the skin
has failed within 8 months. I think the issue is that once the patient
leaves our office they forget the donning and doffing procedure taught to
them in or office. With more patient adjustable features the likelihood of
skin wear and tear go up two-fold. To answer your question, THERE ARE NONE.
If you come across any let me know. I have used the Bock Skin, Skinergy,
Dreamskin, PRS, DAW, just to name a few. I find that with adjustable
setting the patient is better to go with the traditional cover with stocking
cosmesis. Sorry I could not be more of assistance.
I am currently using a fillaur skin with exact same situation. So far so
good.
The only skin I have found to be durable is the Dawskin. I know the company
really is awful to deal with because of the non stop sales calls..but the
skin is great.
Sincerely,
Dale Beckham, CPA, LOPA
Director of Operations
Prosthetic-Orthotic Associates
Citation
dbeckham, “Reponses on Prosthetic Skin,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/229330.
