Silicone Liners Post-Op RESPONSES
B.D.Mitchell Prosthetics
Description
Collection
Title:
Silicone Liners Post-Op RESPONSES
Creator:
B.D.Mitchell Prosthetics
Date:
5/21/2009
Text:
Dear List,
Here are the responses received and additional information:
Try contacting Wallace Faraday of Hanger P and O
Contact Ossur. Ask them about the SMART system
I, and my associate, have been using these for aver 20 years, have had no
complications (repeat no complications) even with brittle diabetic cases.
Early post-operatively I use the Alps Easy Liner without fabric cover for
maximum compliance with minimal donning resistance. I then progress to
appropriate sizing and Alps with cloth covering which offers greater
compression - thereby oedema control. Subsequently I will use any
manufacturer type that I plan to use for the actual suspension or cushion in
prosthetic fitting. I call these HCI's = Post-Operative Hypobaric Cushion &
Compression Interface for amputation residual-limb
I have done this occasionally with success. The only problem seems to be a
higher rate of skin irritation.
Whether this is due to an increased sensitivity immediately post-op, poor
hygiene in the hospital environment or something else, I do not know.
There is a system called KIWI system which Hanger uses. Its just like a Post op rigid dressing but they use a liner first on top of the stump and then apply the rigid cast. I have heard really good things about it but haven't used the system personnaly. One of the disadvatages I have seen with this system is the constant follow ups. Benefits include early stump maturation because of total contact and early post op prosthesis fitting. You may get more information from some one working for Hanger I guess.
The use of silicone liners for control of post op swelling and shaping of
the residual limb is beneficial to the patient but it can be expensive. In
many cases the use of the liner post op works well when minimal dressing is
use. adaptic or other nonadherent dressings over the suture line is usual
all that is needed unless the is excess drainage from the amputation. The
use of the liner with a bivalve socket like Flo Tech or similar accommodate
bulbous or unusual shapes fairly well. The real issue is follow up care by
nursing staff and prosthetist. In a hospital and rehab setting that's easy
but when home care is involved the patient and practitioner taken on added
responsibility. The patient must be compliant and the prosthetist must see
the patient frequently. This can be come tedious and time consuming early on
but if done right the healing and ambulation process is faster. IPOPs have
always increased the healing and ambulation process when supervised properly
but like all good things its only as good as the people involved. The
articles about the Swedish report are in a country where the patient has
socialized system where costs are controlled. In the US we are somewhat
handicapped by the expense and lack of reimbursement. I know that in Canada
things are also controlled but there are limitations to what the system will
cover when a procedure can be considered experimental. Getting back to the
liner system, I found that using cushion liners like Alps, Silipos, Alpha
all work well when sized for the patient in the OR. Whether you use a cast,
bivalve or direct form socket I found it best to have an additional pad
distally external to the liner at the distal end of the socket. This helped
when the patient begins to shrink and drops down into the socket. After the
first seven to ten days the surgeons usually remove the sutures and use
strei strips on the wound. The liner is applied directly over the residuum
and adjustments for reduction are made with socks. This continues for the
first 14 days at that point if the procedure is going well its time to
change the socket. At this point the choice of socket is based on the
condition of the residual limb and the skin. along the suture line. The most
amazing thing is how well in the silicone environment the scar tissue heals.
The process continues until enough maturation of the residual limb allows
casting for a more definitive or preparatory prosthesis. This is the basics
of the procedure the wound care guidelines and the level of weight bearing
are basically the same as those originally outlined in the plaster casting
procedure.
Hope this helps you in deciding how to proceed. If you need more info or
have any questions please feel free to get in touch.
It's a nwer version of a rigid Dressing created by DR> WU at the Rehabilitation Institute of Chicago...I used them as a therapist in the early 80's and there have been many a spinoff...ie Hanger's KIWI which uses a gel liner AND a rigid dressing...I think if you look up the original rigid dressing technique that used tube socks you will find that they just trimmed a few layers of socks to snug up the dog ears...makes for a quick recovery and early weight bearing...good luck just google it or contace Northwestern Univ.
I am already very familiar with ALPS Easyliners and we currently fit almost all new TT amputees with removable rigid fibreglass casts 3-5 days post-op over a generous fluff of stump socks. Using the Easyliners in the removable casts would seem to be a natural transition. These liners are very elastic and will fit over a bulbous new stump much better (and more comfortable) than silicone. Easyliners essentially fit like custom liners. Because of the elasticity they shrink with the stump and do not need to be replaced at every 2cm reduction in limb girth. They are not autoclavable (like silicone) but are about half the price of silicone liners. This sounds like essentially what Hanger calls the KIWI system. The goals still achieved are: earlier mobilization due to less strain on a new wound and more comfort to the patient, edema control, smoothing of scar tissue.
Markus Saufferer, C.P.(c)
Here are the responses received and additional information:
Try contacting Wallace Faraday of Hanger P and O
Contact Ossur. Ask them about the SMART system
I, and my associate, have been using these for aver 20 years, have had no
complications (repeat no complications) even with brittle diabetic cases.
Early post-operatively I use the Alps Easy Liner without fabric cover for
maximum compliance with minimal donning resistance. I then progress to
appropriate sizing and Alps with cloth covering which offers greater
compression - thereby oedema control. Subsequently I will use any
manufacturer type that I plan to use for the actual suspension or cushion in
prosthetic fitting. I call these HCI's = Post-Operative Hypobaric Cushion &
Compression Interface for amputation residual-limb
I have done this occasionally with success. The only problem seems to be a
higher rate of skin irritation.
Whether this is due to an increased sensitivity immediately post-op, poor
hygiene in the hospital environment or something else, I do not know.
There is a system called KIWI system which Hanger uses. Its just like a Post op rigid dressing but they use a liner first on top of the stump and then apply the rigid cast. I have heard really good things about it but haven't used the system personnaly. One of the disadvatages I have seen with this system is the constant follow ups. Benefits include early stump maturation because of total contact and early post op prosthesis fitting. You may get more information from some one working for Hanger I guess.
The use of silicone liners for control of post op swelling and shaping of
the residual limb is beneficial to the patient but it can be expensive. In
many cases the use of the liner post op works well when minimal dressing is
use. adaptic or other nonadherent dressings over the suture line is usual
all that is needed unless the is excess drainage from the amputation. The
use of the liner with a bivalve socket like Flo Tech or similar accommodate
bulbous or unusual shapes fairly well. The real issue is follow up care by
nursing staff and prosthetist. In a hospital and rehab setting that's easy
but when home care is involved the patient and practitioner taken on added
responsibility. The patient must be compliant and the prosthetist must see
the patient frequently. This can be come tedious and time consuming early on
but if done right the healing and ambulation process is faster. IPOPs have
always increased the healing and ambulation process when supervised properly
but like all good things its only as good as the people involved. The
articles about the Swedish report are in a country where the patient has
socialized system where costs are controlled. In the US we are somewhat
handicapped by the expense and lack of reimbursement. I know that in Canada
things are also controlled but there are limitations to what the system will
cover when a procedure can be considered experimental. Getting back to the
liner system, I found that using cushion liners like Alps, Silipos, Alpha
all work well when sized for the patient in the OR. Whether you use a cast,
bivalve or direct form socket I found it best to have an additional pad
distally external to the liner at the distal end of the socket. This helped
when the patient begins to shrink and drops down into the socket. After the
first seven to ten days the surgeons usually remove the sutures and use
strei strips on the wound. The liner is applied directly over the residuum
and adjustments for reduction are made with socks. This continues for the
first 14 days at that point if the procedure is going well its time to
change the socket. At this point the choice of socket is based on the
condition of the residual limb and the skin. along the suture line. The most
amazing thing is how well in the silicone environment the scar tissue heals.
The process continues until enough maturation of the residual limb allows
casting for a more definitive or preparatory prosthesis. This is the basics
of the procedure the wound care guidelines and the level of weight bearing
are basically the same as those originally outlined in the plaster casting
procedure.
Hope this helps you in deciding how to proceed. If you need more info or
have any questions please feel free to get in touch.
It's a nwer version of a rigid Dressing created by DR> WU at the Rehabilitation Institute of Chicago...I used them as a therapist in the early 80's and there have been many a spinoff...ie Hanger's KIWI which uses a gel liner AND a rigid dressing...I think if you look up the original rigid dressing technique that used tube socks you will find that they just trimmed a few layers of socks to snug up the dog ears...makes for a quick recovery and early weight bearing...good luck just google it or contace Northwestern Univ.
I am already very familiar with ALPS Easyliners and we currently fit almost all new TT amputees with removable rigid fibreglass casts 3-5 days post-op over a generous fluff of stump socks. Using the Easyliners in the removable casts would seem to be a natural transition. These liners are very elastic and will fit over a bulbous new stump much better (and more comfortable) than silicone. Easyliners essentially fit like custom liners. Because of the elasticity they shrink with the stump and do not need to be replaced at every 2cm reduction in limb girth. They are not autoclavable (like silicone) but are about half the price of silicone liners. This sounds like essentially what Hanger calls the KIWI system. The goals still achieved are: earlier mobilization due to less strain on a new wound and more comfort to the patient, edema control, smoothing of scar tissue.
Markus Saufferer, C.P.(c)
Citation
B.D.Mitchell Prosthetics, “Silicone Liners Post-Op RESPONSES,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/230182.
