Seal in Poll from a long time ago

Seal in Poll from a long time ago

Barnhart Prosthetics

6/29/2009

A few months ago, I conducted an informal poll about seal i
Hello all,

A few months ago, I conducted an informal poll about seal in liners,

Following are the results of the poll.

Sorry for the delay in posting the results.  It did generate a lot of responses.

Nathan Keepers, CPO



Subject: [OANDP-L] Seal-In Liner Poll

Hello,

I am taking an informal poll regarding a modification to the seal in liner that I would like to see.  I would like to see the addition of a pin lock attachment in combination with the seal in as well.  This would provide additional security to the patients who occasionally lose suction with their seal in liners, but otherwise do fairly well with them.  I have had patients that have been switched to the seal in because they were experiencing pistoning with their pin locking liners.  The seal in has the advantage of no pistoning and rotation control, however, patients have at times lost suction, and don't have the confidence in their suspension that they had with the pin.  I have mentioned this to a couple of different Ossur folks who claim that you don't need it.  I believe this may be the case with the perfect candidate for the Seal in as it is currently made, but with a pin lock could be suitable for more patients, such as ones with larger volume
fluctuation than the Seal in is reccomended for. 

My question is:  If Ossur were to manufacture a pin locking Seal-In liner, would you use this with your patients?

Thanks,

Nathan Keepers, CPO
 
I do this application on any seal in liner patient.  Use a three prong
threaded adapter and if the seal in does not work, install a Timed lock.  No
brainer. 
Have you ever suggested that your patients use a suspension sleeve in conjunction with the seal in liner.
No. Then they would have to hold the pin release and the suction release to get the thing off, unless they completely unscrew the valve.  I would like to see one thing changed, that is the price!  $xxx, for a single seal and an outrageous $xxx for the multi-seal.  90% of my contracts don't even cover the cost of the liners for me to provide them to all the patients I would like to put them on!
Yes - to support your poll results reporting to Ossur.
Interesting concept and one that might work very well for certain
situations.  I would worry about the alcohol corroding the locking
mechanism. 
Sounds like a great idea to me.  I had an AK patient who used a seal-in and liked it very much until some volume fluctuations caused occasional loss of suspension.  He somewhat reluctantly changed to a pin with a TES belt as auxillary suspension.  He still does not feel the suspension is as good as the seal-in was, but he likes the sure security of the pin.  We recently allowed him to try a new 5-ring AK liner and explained that this should be better than the old single ring and that loss of suspension should be greatly minimized or eliminated.  He liked the new 5-ring but now just can't give up the peace of mind the pin offers.  I think a seal-in/pin combo liner would be the perfect solution for any patient with a similar history.  Thanks.
I like the idea.  I'd buy one.  I think the Seal in liner, which has gone through seal improvements, might have a thinner distal end profile than a pin suspension design.  Therefore, Ossur might experience molding expenses making a hybrid design.
 
It is my un-scientific observation that prosthetists who use pins are more flexible employing sleeve suspension systems in their designs, but those who use primarily sleeves are committed and think pins are medieval torture devices.  Therefore, Ossur might not think there is a market for a hybrid system as you propose.  Your thoughts
i would give it a try as i believe it would give a addtiional confidence to
the wearer. i wonderv  aboutement reimbers
I agree with you regarding the reliability problem of  seal-in liner suspension. After several patients complained of  difficulty I began to give the system  second  thoughts. Slight  volume  changes  and  position changes  gave the most  problem. Most  frequently it  seemed that  loss of suction occurred during  seating or moving in/out of a seated position (small cars  especially). Pins  are difficult for most heavier AK patients especially  those  who are weaker due to exact positioning. Also in these  patients compression of soft tissue to push  the pin into place becomes a problem leading to pistoning.  I've come to rely primarily on a simple lanyard  suspension method when there is any chance of  volume changes causing suspension loss. The occasional problem of rotation   can  be  controlled  by using  velcro.
 
It will be interesting to see the respnses. 
Thanks  for the thoughtful question.
I would not use an Ossur Seal in liner with a pin added
YES and YES.  Our experiences and opinions are the same as yours! 
Let;s hope it will fall on receptive ears.
Failing that, maybe another liner manufacturer wants to take on this
challenge.
We have attached a pin to a seal in liner for a short AK stump.The patient lost suction after prolonged sitting. I don't know if the market is there for mass production as it has not been necessary for all our other candidates but it would be nice to have it as an option.
Good idea, I'd certainly use it occasionally.
Regards,
Agree.  Particularly for the transfemoral amputees
I doubt i would use that dual setup. You would need lock like coyote that would be able to accept the pin and create suction all in one for benefits of both that you are looking for. I have fit many seal in liners but as you noted in your post volume fluctuation control is key. The five seal  seal in liner should prevent loss of suction that sometimes was problematic with the single seal liner. I dont like to fuss with distal cups or socks so i am particular with the type of limb and amputee that i fit them on.
I guess my question is why not just use a pin only.  How would you seal the liner if there is a shuttle.  Would you use a sealing locking system?  Ig guess I see the benefit of locking and sealing which would be nice to have an expulsion valve pin system and the anti piston action of the seal liner.  Most of my seal ins are due to a lack of height for a locking liner.
Thanks
Yes
I'm with Ossur on this one - I don't think this is a necessary product-either choose a locking liner or a seal-in. We have been fitting seal-in liners since their inception with no loss of suction issues, providing the patient manages their volume loss with the appropriate sock ply.  The problem I often see is the socket being made with incorrect proximal tension and I think there is more chance of loss of suction in that case. 
Just my 2 cents worh
maybe.  I am reluctant, but maybe

    I am curious as to which lock you would plan to use. There are only
a couple locks that have the ability to hold a seal.
I would consider this on a rare occasion.  Insurance doesn't usually pay for both locking and suction. I would more likely just add a suspension sleeve.
 
Yes.
That would be the perfect combination as all too often a loss of seal occurs due to decrease in volume or more likely, volume loss combined with body position/activity.
Even the ideal pt looses confidence in the system w/one incident of suspension loss.
 
By combining the seal-in with the pin we can eliminate the more aggressive socket shape used in the pin system to reduce or eliminate rotation.
 
Interesting post.
I quit using the seal in because I was getting reimbursed less than it cost me
Yes !!
If the seal could always be located at its most proximal location, then this would be of some benefit.  A pin lock would do nothing other than anchor the system....and it still would piston.  The seal in liner is a distal suspension mechanism just like the pin and they both have a propensity to milk the limb and encourage volume fluctuations.  When this happens, pistoning is inevitable.
hello there, i probably wouldnt use it as i feel if the patient has too large a volume fluctuation for seal in to work effectively then you have the wrong prescription.
I have a patient who rejected the Seal in liners because she didn't feel
secure in them after she lost suction and fell.  This would be a good answer
to that problem.  Could you then bill for both suction suspension and a
locking mechanism, or do you think it would be a write off?  Just a thought
Hello, I use the Seal-In liners A LOT & have yet to have anyone loose suction, even transtibial pt's w/ some volume fluctuation.  I don't think I would use a Seal-in w/ pin lock, it seems like over kill.  If they had that much volume fluctuations I would stick with a pin system.
I would use this hybrid pin/seal liner. I think it's a good idea. My patients have expressed the same concern you bring up
I would, but the lock would have to be sealed, so  Coyote lock unless Ossur has one.  I think it would be great.  They also need to discontinue the older sealin, with one fold.  The new one is the only one I have had success with
This is a very question raised by 2 of our military patients. I cant see how pin and seal-in would work unless you are relying on the suction between the X5, or are you looking at some sort of seal around the pin? The 2 patients have the same concerns you expressed and have said they have spoken to (sorry I forget his name) the prosthetic military link with ossur who said he would get them to make one??
Hey,

I would like to see a poll of how many patients have been injured in falls
due to loss of suction. I would bet the majority of them were TT. 

I have had very good results with the TF liner, and very poor results with
the TT.

As for your poll;
I would not use the pin option.

I will not use this system on TT patients again.

I have no confidence in the seal-in for TT. I believe Ossur has it wrong.

The Coyote Air-Lock is a closed system.  I prefer it with whatever your
liner preference is, and a sleeve. This allows pin suspension when
convenient and auxiliary negative suction when needed. 
A pin would prevent it from being a hematoma looking for a place to happen. I would still not use it.
I am thinking that incorporating a pin & lock to a seal in liner would create a source for loosing vacume through the pin-lock attachment point. Since vacume is the primary source of suspension with the seal in liner it would seem to me that the addition of a pin & lock would negate this primary suspension source and would therefore not justify the use of a seal in liner. Just my 2 cents worth.
The reason I have used the Seal-in liner is to accommodate a long residual limb. The addition of a lock would have precluded using the liner. There may be times when having the lock would be an advantage but these cases would be the exception not the rule
This is a good idea! Ossur could make one production item and you could decide to use a pin or not.
Nathan...  I too have mentioned the same to our Ossur Rep and wholeheartedly concur with your thinking and the need for a seal-in liner with a shuttle pin for added security. 
 
However, the primary reason I see this need is because the seal-in vacuum suspension minimizes the distal end distraction of soft tissue that, in my experience, has led to individuals not accepting a total shuttle pin/liner suspension system, due to the distal end pain or discomfort it causes.  However, in every case the individual liked the security of the shuttle pin/liner suspension system. 
 
I most cases it has been my opinion the failure of a total shuttle pin/liner suspension system has been the result of sensitive nerve endings within the distal end or nerves that are scared down in soft tissue, which do not tolerate the distal distraction and results in pain or discomfort during swing phase.
 
The only way I have gotten around this problem is to utilize a vacuum suspension sleeve in conjunction with a shuttle pin/liner suspension system; however, I have found many individuals do not like the extra bulk over their knee that restricts knee flexion ROM.
 
Aside for this, the only other problem I have found with the seal-in liner system is appropriately adjusting for volume changes with half socks above the sealing webs or vacuum baffle(s).
 
Having expressed the above and in answer to your question:  If I had an individual with a reasonably stable limb size I would consider using a reasonably priced Ossur seal-in shuttle pin gel liner, if it were available or at least offered as a custom fabricated gel liner option.
 
I hope this is of some help to you and your informal poll!... 
yes indeed!!!  With the airlock
Yes, yes yes!!!
I just saw a patient yesterday who is injured because they lost suction in their seal in leg
I might try it, but really in my experience if the socket fits, you really don't need it. I use this system on 90% of my transfemoral fittings.

You might try to fit your sockets a bit tighter proximally or maybe your patients are experiencing more volume change than average.

Great question.
Have you tried the coyote suction locking system? It utilizes a pin and has a built-in one way suction valve that releases the suction only when then lock button is released.
I would certainly use a product like this and have even asked our Ossur representative for such an item.  I work for a manufacturer of prosthetic components and we recently released a shuttle lock for use with Elevated Vacuum and passive suction systems that the Seal-In liner would work very well with, if only it had a pin attachment.

I think the response you got from the people at Ossur is typical when they don't have an answer to your needs.  I'm not trying to put them down; I think they respond in such a way because it is very difficult for them to get changes made in their engineering department.  However, I do think it's absurd for them to think that you don't need some sort of auxiliary suspension with their product and hopefully they take our requests seriously.
Yes
Yes, I think it is a good option, for the reasons you stated
Try Coyote Designs locking system.  I like the seal in as is
No, I would not use it.  I want to get away from the pin which is why I would choose a seal-in
No. Never.
I probably wouldn't use them. If I have a patient with seal leak problems, I look first to the valve, then liner fit, then the socket. If there was a pin attachment, that implies there is also a lock. That lock would have to be air-tight for the seal to still work. The only air tight lock I've seen is Coyote, and I think its just too much to go wrong in one prosthesis, to expect a functional lock to be completely and absolutely air tight. Just my thoughts