RESPONSES: New 6Y80 Adapt Transfemoral Liner & Blistering
Description
Collection
Title:
RESPONSES: New 6Y80 Adapt Transfemoral Liner & Blistering
Date:
9/16/2010
Text:
Dear List... Below are the 4 responses I received to my post regarding the blistering problem we have encountered with the new Otto Bock 6Y80 Adapt Transfemoral Liner & Blistering. Much of the information from the respondents confirmed things we have concluded or tried in the past with any gell liner and none were specific to the Otto Bock 6Y80 liner.
I would also add we previously tried the suggested additional sock option between the limb and liner; however, they essentially did not like the feel or the lessened vacuum suspension between the liner and their limb, even realizing once a degree of perspiration occurred their suspension would be improved. One comment was: I didn't have to use a sock with my old liner and I didn't have to wait for the suspension to get better. It was immediate. It's hard to argue that one!!!
My sincerest thanks and appreciation to those of you who responded!
John N. Billock, CPO/L, Clinical Director
Orthotics & Prosthetics Rehabilitation Engineering Centre
Warren, Ohio 44484 USA
Original Post ---------------------------------------------------------------------------------------------------------------------------
We have recently experienced 3 cases with 3 different patients of our with transfemoral A/K amputations that has been fit with new 6Y80 Adapt Tranfemoral Liners and developed blisters throughout their residual limb. These liners are not the sanitized version and their is a definite difference in the interface surface between the old an new liner. The old liner had more of a smooth glossy finish and the new version of the liner has more of a mat textured finish.
Each individual has a rather fleshy limb and claims to have sensitive skin. They also feel they are allergic to the new silicone gel material, which is contrary to what we have been advised, as we have discussed this situation with Otto Bock and they indicate they have had no reports of the occurrence we have described.
Two of the individuals had previously been wearing the older version of the 6Y80 Adapt liner without this problems. The only conclusion we can come to, is the surface difference between the new and old liner.
I would appreciate knowing if anyone else has experienced this problem or has any ideas on what would cause the blistering or suggestions on preventing and resolving the problem?
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RESPONSES:
1. -------------------------------------------------------------------------------------------------------------------------------------------
It seems from my experience that the allergic reaction is often mis-diagnosed. I believe that most of the blistering issues are caused by friction burns, similar to the indian burns that we would do as kids to each others arms. With a liner being new, it is more tacky and also not as stretched out. Further, with an AK, the muscle contraction occurs inside the socket, causing more movement internally and on the skin as compared to a BK prosthesis.
For the BK, adding a one ply, liner-liner, sheath, or cut piece of stockingette helps. You can also add baby powder and then knock it out to limit the tackyness. This happens more so on the edge of the liner where it ends, and more-so on the silicon liners than the elastomer ones, as silicon will not flow as their molecules are more stable and do not flow.
With the AK, since it likely is held on more by suction and tension values increasing the friction, and there is a larger pendulum of centripetal force trying to pull it off, it is more difficult to accomodate. I would evaluate your patient to see how to lessen the tackyness, or see if a sock between the limb and the liner stops the blisters. Hope this helps.
2. ---------------------------------------------------------------------------------------------------------------------------------------------
The different texture was a problem for a couple of my patients when we fitted the new version. I had them use the Sensi-cream from Convatec. The
cream allowed the tissue to tolerate the new texture without any additional issues. I also had one patient who needed to use a Comfort liner sock which help alleviate their problem. In all these cases the problem with the skin occurred on the proximal end. The patient that needed the liner sock had the problem on the distal end. I also recommend checking the sizing of the liner because with the broad distal end plate sometimes the liner does not conform as well and causes gapping which can also cause irritation and breakdown. In one case I had to switch completely to an Ossur Transfemoral liner. I hope this information helps.
3. ----------------------------------------------------------------------------------------------------------------------------------------------
El paciente puede presentar hongo por humedad en el muÑon, eso provoca hipersensibildad, que sude en mucho y que salgan ampollas o supure agua , lo que se recomienda es un tratamiento con miconazol ,clotrimazol o algún fungicida tópico para hongo en la piel o bien canalízalo al Dermatologo para su tratamiento.
También seria bueno revisar que cuidado y como lava el paciente su encaje, ya que si no lo hace de forma correcta todos los residuOs del sudor causan irritaciones en la piel,. Espero que esta indicaciones le resulten utiles.
English Translation:
The patient can present mold from moisture in the stump, this causes hypersensitivity to excessive sweat, and blistering or oozing fluid. It is recommended that you treat it with miconazol, clotimazol or some other topical fungicide for mold on the skin, or consult with a dermatologist for treatment.
Also, it would be good to carefully review proper washing with the patient as they are fit, because if not done correctly all the residue from the sweat causes irritations to the skin. I hope that this information is useful to you
4. ------------------------------------------------------------------------------------------------------------------------------------------------
I have not used the OB liner you refer to. But, I have used the Evolution liner, which is silicone and have had no problems with skin problems to date. As you may know, their liner is made with the same materials used in catheters. I personally like the liner, but have not used all that many of them, because I use Alpha a lot. Alpha, by the way, just came out with a Select liner that is 9mm distally, 6mm up the crest, and 2.5mm elsewhere and it has a soft center area that allows the liner to stretch easily over the patella for sitting. I think they my be on to something with it. The cushion version is due out at the end of this month. It is a cross between silicone and Alpha, but really has no literal silicone in it. It is just a much firmer material, more similar to silicone liners. I started using the Aura sock from Evolution until it was pulled from the market due to patent issues with Ossur. To put if mildly, I was VERY impressed with the sock and it did a great job of creating a seal for vacuum, or suction suspensions. I can't wait until something similar comes out again and hope it will be soon, but knowing the patent and attorney stuff, it will likely be in the next lifetime.
End of Responses ----------------------------------------------------------------------------------------------------------------------
P Please consider the environment before printing this e-mail.
Please consider the environment before printing this e-mail.
I would also add we previously tried the suggested additional sock option between the limb and liner; however, they essentially did not like the feel or the lessened vacuum suspension between the liner and their limb, even realizing once a degree of perspiration occurred their suspension would be improved. One comment was: I didn't have to use a sock with my old liner and I didn't have to wait for the suspension to get better. It was immediate. It's hard to argue that one!!!
My sincerest thanks and appreciation to those of you who responded!
John N. Billock, CPO/L, Clinical Director
Orthotics & Prosthetics Rehabilitation Engineering Centre
Warren, Ohio 44484 USA
Original Post ---------------------------------------------------------------------------------------------------------------------------
We have recently experienced 3 cases with 3 different patients of our with transfemoral A/K amputations that has been fit with new 6Y80 Adapt Tranfemoral Liners and developed blisters throughout their residual limb. These liners are not the sanitized version and their is a definite difference in the interface surface between the old an new liner. The old liner had more of a smooth glossy finish and the new version of the liner has more of a mat textured finish.
Each individual has a rather fleshy limb and claims to have sensitive skin. They also feel they are allergic to the new silicone gel material, which is contrary to what we have been advised, as we have discussed this situation with Otto Bock and they indicate they have had no reports of the occurrence we have described.
Two of the individuals had previously been wearing the older version of the 6Y80 Adapt liner without this problems. The only conclusion we can come to, is the surface difference between the new and old liner.
I would appreciate knowing if anyone else has experienced this problem or has any ideas on what would cause the blistering or suggestions on preventing and resolving the problem?
----------------------------------------------------------------------------------------------------------------------------------------------
RESPONSES:
1. -------------------------------------------------------------------------------------------------------------------------------------------
It seems from my experience that the allergic reaction is often mis-diagnosed. I believe that most of the blistering issues are caused by friction burns, similar to the indian burns that we would do as kids to each others arms. With a liner being new, it is more tacky and also not as stretched out. Further, with an AK, the muscle contraction occurs inside the socket, causing more movement internally and on the skin as compared to a BK prosthesis.
For the BK, adding a one ply, liner-liner, sheath, or cut piece of stockingette helps. You can also add baby powder and then knock it out to limit the tackyness. This happens more so on the edge of the liner where it ends, and more-so on the silicon liners than the elastomer ones, as silicon will not flow as their molecules are more stable and do not flow.
With the AK, since it likely is held on more by suction and tension values increasing the friction, and there is a larger pendulum of centripetal force trying to pull it off, it is more difficult to accomodate. I would evaluate your patient to see how to lessen the tackyness, or see if a sock between the limb and the liner stops the blisters. Hope this helps.
2. ---------------------------------------------------------------------------------------------------------------------------------------------
The different texture was a problem for a couple of my patients when we fitted the new version. I had them use the Sensi-cream from Convatec. The
cream allowed the tissue to tolerate the new texture without any additional issues. I also had one patient who needed to use a Comfort liner sock which help alleviate their problem. In all these cases the problem with the skin occurred on the proximal end. The patient that needed the liner sock had the problem on the distal end. I also recommend checking the sizing of the liner because with the broad distal end plate sometimes the liner does not conform as well and causes gapping which can also cause irritation and breakdown. In one case I had to switch completely to an Ossur Transfemoral liner. I hope this information helps.
3. ----------------------------------------------------------------------------------------------------------------------------------------------
El paciente puede presentar hongo por humedad en el muÑon, eso provoca hipersensibildad, que sude en mucho y que salgan ampollas o supure agua , lo que se recomienda es un tratamiento con miconazol ,clotrimazol o algún fungicida tópico para hongo en la piel o bien canalízalo al Dermatologo para su tratamiento.
También seria bueno revisar que cuidado y como lava el paciente su encaje, ya que si no lo hace de forma correcta todos los residuOs del sudor causan irritaciones en la piel,. Espero que esta indicaciones le resulten utiles.
English Translation:
The patient can present mold from moisture in the stump, this causes hypersensitivity to excessive sweat, and blistering or oozing fluid. It is recommended that you treat it with miconazol, clotimazol or some other topical fungicide for mold on the skin, or consult with a dermatologist for treatment.
Also, it would be good to carefully review proper washing with the patient as they are fit, because if not done correctly all the residue from the sweat causes irritations to the skin. I hope that this information is useful to you
4. ------------------------------------------------------------------------------------------------------------------------------------------------
I have not used the OB liner you refer to. But, I have used the Evolution liner, which is silicone and have had no problems with skin problems to date. As you may know, their liner is made with the same materials used in catheters. I personally like the liner, but have not used all that many of them, because I use Alpha a lot. Alpha, by the way, just came out with a Select liner that is 9mm distally, 6mm up the crest, and 2.5mm elsewhere and it has a soft center area that allows the liner to stretch easily over the patella for sitting. I think they my be on to something with it. The cushion version is due out at the end of this month. It is a cross between silicone and Alpha, but really has no literal silicone in it. It is just a much firmer material, more similar to silicone liners. I started using the Aura sock from Evolution until it was pulled from the market due to patent issues with Ossur. To put if mildly, I was VERY impressed with the sock and it did a great job of creating a seal for vacuum, or suction suspensions. I can't wait until something similar comes out again and hope it will be soon, but knowing the patent and attorney stuff, it will likely be in the next lifetime.
End of Responses ----------------------------------------------------------------------------------------------------------------------
P Please consider the environment before printing this e-mail.
Please consider the environment before printing this e-mail.
Citation
“RESPONSES: New 6Y80 Adapt Transfemoral Liner & Blistering,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 23, 2024, https://library.drfop.org/items/show/231830.
