Responses to silicone liner
Schafer, Kristin
Description
Collection
Title:
Responses to silicone liner
Creator:
Schafer, Kristin
Date:
10/27/2010
Text:
Once again, I thank you all for your time to respond to my question. You
have a wealth of knowledge to share! To the Ossur Rep who called me I
will call you back...just haven't had enough time yet.
In speaking with my patient today she said that in fact there were no
welts in the distal area, that they were all over the rest of the limb
though. I did not wash out the liner first. She also said that even
though her skin is almost healed she still experiences a burning
sensation. I advised her to use her other prosthesis for the time being
and wait for her limb to get back to normal before trialling a freshly
cleaned liner. I will advise her to try just the liner without the
socket for a few hours/days if she can manage and then incorporate a
wearing schedule to acclimate to the new state in the liner.
Kindest regards!
Kristin Schafer
Here are the responses:
Kristin, this sounds like a silicone reaction on the skin. To be sure
have the client try to sleep with the liner on and see how the skin
reacts. Good luck
------------------------------------------------
I have fit 100's of patients with seal-in liners and have never
encountered what you report (if the sores are literally all over her
limb.) I doubt it is an allergy, but I would do a swatch test somewhere
else on her body. Also, I would double check the sizing of the liner and
that she has distal contact in her socket (especially if the blisters
are mainly distal?). The soap patients use is always a variable as well.
If the blisters are mainly at the proximal limb I would consider a
conical shaped seal-in (if the measurements agree.) As a last resort, I
have on rare occasion used a sheath or liner liner (by knit-rite) under
the liner. Hope I helped some.
------------------------------------------------------------------------
-------------------------
It sounds like she was getting a void under the distal end when she sat
down and the vacuum pulled the water out of her leg in the form of
blisters and fluid. Make sure she stays on the bottom of her socket and
it will clear up in a couple days if that's it.I have been fitting them
for years and only had one person that had a reaction to the material.
Make sure the valve doesn't leak by filling the socket with water.Hope
this helps.
------------------------------------------------------------------------
-------------------------
People can be allergic to anything but those liners are pretty
hypoallergenic. Did alcohol get sprayed into the liner? I've had pt's do
that and get the same reaction. I've read where a CP left a liner out on
his bench while he ground through some carbon fiber and the airborne
carbon dust got on the liner and that caused welts on the pt. Perhaps it
was just coincidence. To rule out a true allergy, take a scrap piece of
liner and put it on her other leg and see if any reaction occurs.
------------------------------------------------------------------------
-------------------------
I have seen people react to liners if you do not wash them out of the
box before putting them on the patient. I think there is a mold release
agent on the liners from manufacture.
----------------------------------------------------------------
Sounds like an allergic reaction to the silicone, if it happened that
quickly, and was over the entire limb, versus just the distal end or
above the seal. Alternative would be different liner material with
liner, or skin suction with pull in. I would do the first versus the
last.
-----------------------------------------------
I have had this occur a couple of times. One was a patient wo had worn a
seal-in for a year and then got a new one. She had the same problem you
describe almost right away. We exchanged the liner and it cleared up
right away. Ossur couldn't give us any answers other than possible
contanimation during manufacturing. The other client had some
underlying skin issues that got worse with the Ossur seal in. Switched
to Urethane and problems went away. Had one other BK who had a reaction
to a regular dermo but it cleared up by using a sheath under the liner.
We use a lot of seal-in liners with usually great results. Hope you
figure things out, feel free to call me.
-----------------------------------------------
I have used a handful of BK/AK and none had received that type of
reaction.
There are so many variables. I suggest you call Ossur but the few you
could check on are: Sizing = measurement 4cm from distal end.....5seal
=keep that measurement, single seal= undersize it by 1 size...
When modifying the cast, Did you reduce from the seal /proximal.?
When you fit the check socket, Did you see a nice smooth transition
around the ring?
Did you use the TF liner?
There are also two types of liner. Conical and Regular
--------------------------------------------------------------
Sounds like your patient unfortunately is suffering from Cholinergic
Urticaria, a fairly common form of heat hives:
<URL Redacted>
<URL Redacted>
These people experience hives upon increases in body heat, and in
prosthetics this is frequently seen under the gel liners. There is some
thinking that they are allergic to their own sweat, and treatment
protocols are varied and a number of them are mentioned in the websites
above. Have you tried the liners with built-in cooling systems?
(actually, they are only on the concept board at this time)
If you want to continue with the Seal-In liner system, see if your
patient can manage with a DAW sheath under the liner. That sometimes
makes the difference. You may have already done this so it may not
pertain, but make sure you give new Ossur liners a good cleaning before
offering them to the patient, as there could be some trace mold release
chemicals still on the liner, fresh out of the package, and your patient
may have a chemical sensitivity.
Good luck with your efforts here,
-----------------------------------------------
#1 Was the liner washed real well
oils from factory can cause it
#2 Didnt say where blisters were
If on distal end....not total contact
#3 Could have alergic reaction to silicone
----------------------------------------------
With some patient they do not break suction when they sit; as with the
fleshy thigh flattening down, or the tibial area breaking away to lose
suction. I advise all my pin patients to release the suction on the
valve so that the pull is not milking or shearing the skin. You may have
such a total contact fit that the suction is pulling too strong, or if
she is a new amputee she is getting a heat rash (sockets do get warm;
imagine being in a 98.6 degree room and no air circulation). That is why
a limb inner liner sheath can help. For a sear in liner you may have to
use an distal open sheath. See if Ohio Limb Sterling Sock Company will
knit a sheath with a open distal end and a roll over top 2 overlap the
brim. You have to contact Ohio Wilow Wood in the USA.
-------------------------------------------------------------
Friction blisters! Movement within the liner!
-------------------------------------------------------------
I've never seen blisters but some people complain of a burning if they
yank the liner up instead of rolling it.
-------------------------------------------------------------
Please forward your responses. I had a similar situation with a
Transtibial socket with locking pin...I am expecting images from the
patient to help clarify.
Many thanks and appreciation in advance.
---------------------------------------------
Sounds like an allergic reaction to me. I have had a few people that had
problems with the mold release used by Ossur. If you wash the liner out
with soap to remove it, it usualy fixes the problem. Hope that helps.
------------------------------------------------------------
Kristin,
More than likely this is caused by a friction burn, similar to the
indian burns one did as a child, where the shear created by the liner to
skin interface causes issues.
-----------------------------------------------------------
I noticed that fresh from the box they need to be washed. Perhaps it
was a reaction to the gel debris?? It could also be too tight.
----------------------------------------------------------
It is a very interesting case study. One question I would have was the
blisters concentrated or were they evenly distributed? My anecdotal
thought is that there is distal distraction when sitting no matter what
type of prosthesis you use. You can see that in suction without a liner,
with a liner, or a pin. Often you will see patients habitually release
suspension a bit when sitting to relieve this.
Your fitting sounds like it was so good that it held the patient against
the distal end and resisted this migration and in turn placed increased
pressure on the boundary layer of the skin. My experience is that, just
like pressure sores, skin under traction will become irritated
especially if it is light in color or very fragile. Sometimes people
think this is an allergy, but I think it may be the layers of skin
undergoing shear. For example have you ever held a letter in you mouth
and it sticks to your lips. If you pull it away quickly your skin
becomes irritated due to the adhesion and shear. This is one reason they
used to suggest scalloping the top of the liner to prevent this high
transverse hoop tension.
On the flip side some people really do have a skin allergy to silicone
or in a contained environment, not often. I have taken a patch of
material and secured it to an arm or leg with elastic wrap to see if
this was the case. If she had no issues with liners before this can be
ruled out.
My only thought is to slightly release the valve to relieve the pulling
sensation when sitting for a long time. When standing reseat the limb by
pressing on the valve. It sounds like you had a good fitting though.
Hope that helps,
-------------------------------------------
All over? If it was just at the seal and below I'd say it was the
negative pressure. Also sometimes I've had pt.'s leave the distal end
inverted prior to donning which can create an air pocket and pull
blisters distally.
I've never heard of anyone having an allergic reaction to those liners.
Please share you responses as I use these liners a lot.
Thanks and good luck
--------------------------------------------
This has been experienced with some people when changing from
skin/suction to HSI (Hypobaric cushion/Suspension Interface - more
popularly as a
Liner) for those using a silicone/urethane. I see many patients from
out-of-state and have learned to instruct patients NOT to wear the new
prosthesis/liner on the drive home or for any length of time - using a
progressive wearing schedule based on our personal experience.
--------------------------------------------
End of responses.
Kristin Schafer, B.Sc. (Kin.), C.P. (c)
Rehabilitation Engineering
Sudbury Regional Hospital- Laurentian Site
41 Ramsey Lake Rd.
Sudbury, ON
P3E 5J1
(705) 523-7100 x3176
************************************************************************
The information contained in this e-mail and document(s) attached are for
the exclusive use of the addressee and may contain confidential, privileged
and non-disclosable information. If the recipient of this e-mail is not the
addressee, such recipient is strictly prohibited from reading, photocopying,
distributing or otherwise using this e-mail or its content in any way.
********************
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the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>
OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affiliations should be used in all communications.
have a wealth of knowledge to share! To the Ossur Rep who called me I
will call you back...just haven't had enough time yet.
In speaking with my patient today she said that in fact there were no
welts in the distal area, that they were all over the rest of the limb
though. I did not wash out the liner first. She also said that even
though her skin is almost healed she still experiences a burning
sensation. I advised her to use her other prosthesis for the time being
and wait for her limb to get back to normal before trialling a freshly
cleaned liner. I will advise her to try just the liner without the
socket for a few hours/days if she can manage and then incorporate a
wearing schedule to acclimate to the new state in the liner.
Kindest regards!
Kristin Schafer
Here are the responses:
Kristin, this sounds like a silicone reaction on the skin. To be sure
have the client try to sleep with the liner on and see how the skin
reacts. Good luck
------------------------------------------------
I have fit 100's of patients with seal-in liners and have never
encountered what you report (if the sores are literally all over her
limb.) I doubt it is an allergy, but I would do a swatch test somewhere
else on her body. Also, I would double check the sizing of the liner and
that she has distal contact in her socket (especially if the blisters
are mainly distal?). The soap patients use is always a variable as well.
If the blisters are mainly at the proximal limb I would consider a
conical shaped seal-in (if the measurements agree.) As a last resort, I
have on rare occasion used a sheath or liner liner (by knit-rite) under
the liner. Hope I helped some.
------------------------------------------------------------------------
-------------------------
It sounds like she was getting a void under the distal end when she sat
down and the vacuum pulled the water out of her leg in the form of
blisters and fluid. Make sure she stays on the bottom of her socket and
it will clear up in a couple days if that's it.I have been fitting them
for years and only had one person that had a reaction to the material.
Make sure the valve doesn't leak by filling the socket with water.Hope
this helps.
------------------------------------------------------------------------
-------------------------
People can be allergic to anything but those liners are pretty
hypoallergenic. Did alcohol get sprayed into the liner? I've had pt's do
that and get the same reaction. I've read where a CP left a liner out on
his bench while he ground through some carbon fiber and the airborne
carbon dust got on the liner and that caused welts on the pt. Perhaps it
was just coincidence. To rule out a true allergy, take a scrap piece of
liner and put it on her other leg and see if any reaction occurs.
------------------------------------------------------------------------
-------------------------
I have seen people react to liners if you do not wash them out of the
box before putting them on the patient. I think there is a mold release
agent on the liners from manufacture.
----------------------------------------------------------------
Sounds like an allergic reaction to the silicone, if it happened that
quickly, and was over the entire limb, versus just the distal end or
above the seal. Alternative would be different liner material with
liner, or skin suction with pull in. I would do the first versus the
last.
-----------------------------------------------
I have had this occur a couple of times. One was a patient wo had worn a
seal-in for a year and then got a new one. She had the same problem you
describe almost right away. We exchanged the liner and it cleared up
right away. Ossur couldn't give us any answers other than possible
contanimation during manufacturing. The other client had some
underlying skin issues that got worse with the Ossur seal in. Switched
to Urethane and problems went away. Had one other BK who had a reaction
to a regular dermo but it cleared up by using a sheath under the liner.
We use a lot of seal-in liners with usually great results. Hope you
figure things out, feel free to call me.
-----------------------------------------------
I have used a handful of BK/AK and none had received that type of
reaction.
There are so many variables. I suggest you call Ossur but the few you
could check on are: Sizing = measurement 4cm from distal end.....5seal
=keep that measurement, single seal= undersize it by 1 size...
When modifying the cast, Did you reduce from the seal /proximal.?
When you fit the check socket, Did you see a nice smooth transition
around the ring?
Did you use the TF liner?
There are also two types of liner. Conical and Regular
--------------------------------------------------------------
Sounds like your patient unfortunately is suffering from Cholinergic
Urticaria, a fairly common form of heat hives:
<URL Redacted>
<URL Redacted>
These people experience hives upon increases in body heat, and in
prosthetics this is frequently seen under the gel liners. There is some
thinking that they are allergic to their own sweat, and treatment
protocols are varied and a number of them are mentioned in the websites
above. Have you tried the liners with built-in cooling systems?
(actually, they are only on the concept board at this time)
If you want to continue with the Seal-In liner system, see if your
patient can manage with a DAW sheath under the liner. That sometimes
makes the difference. You may have already done this so it may not
pertain, but make sure you give new Ossur liners a good cleaning before
offering them to the patient, as there could be some trace mold release
chemicals still on the liner, fresh out of the package, and your patient
may have a chemical sensitivity.
Good luck with your efforts here,
-----------------------------------------------
#1 Was the liner washed real well
oils from factory can cause it
#2 Didnt say where blisters were
If on distal end....not total contact
#3 Could have alergic reaction to silicone
----------------------------------------------
With some patient they do not break suction when they sit; as with the
fleshy thigh flattening down, or the tibial area breaking away to lose
suction. I advise all my pin patients to release the suction on the
valve so that the pull is not milking or shearing the skin. You may have
such a total contact fit that the suction is pulling too strong, or if
she is a new amputee she is getting a heat rash (sockets do get warm;
imagine being in a 98.6 degree room and no air circulation). That is why
a limb inner liner sheath can help. For a sear in liner you may have to
use an distal open sheath. See if Ohio Limb Sterling Sock Company will
knit a sheath with a open distal end and a roll over top 2 overlap the
brim. You have to contact Ohio Wilow Wood in the USA.
-------------------------------------------------------------
Friction blisters! Movement within the liner!
-------------------------------------------------------------
I've never seen blisters but some people complain of a burning if they
yank the liner up instead of rolling it.
-------------------------------------------------------------
Please forward your responses. I had a similar situation with a
Transtibial socket with locking pin...I am expecting images from the
patient to help clarify.
Many thanks and appreciation in advance.
---------------------------------------------
Sounds like an allergic reaction to me. I have had a few people that had
problems with the mold release used by Ossur. If you wash the liner out
with soap to remove it, it usualy fixes the problem. Hope that helps.
------------------------------------------------------------
Kristin,
More than likely this is caused by a friction burn, similar to the
indian burns one did as a child, where the shear created by the liner to
skin interface causes issues.
-----------------------------------------------------------
I noticed that fresh from the box they need to be washed. Perhaps it
was a reaction to the gel debris?? It could also be too tight.
----------------------------------------------------------
It is a very interesting case study. One question I would have was the
blisters concentrated or were they evenly distributed? My anecdotal
thought is that there is distal distraction when sitting no matter what
type of prosthesis you use. You can see that in suction without a liner,
with a liner, or a pin. Often you will see patients habitually release
suspension a bit when sitting to relieve this.
Your fitting sounds like it was so good that it held the patient against
the distal end and resisted this migration and in turn placed increased
pressure on the boundary layer of the skin. My experience is that, just
like pressure sores, skin under traction will become irritated
especially if it is light in color or very fragile. Sometimes people
think this is an allergy, but I think it may be the layers of skin
undergoing shear. For example have you ever held a letter in you mouth
and it sticks to your lips. If you pull it away quickly your skin
becomes irritated due to the adhesion and shear. This is one reason they
used to suggest scalloping the top of the liner to prevent this high
transverse hoop tension.
On the flip side some people really do have a skin allergy to silicone
or in a contained environment, not often. I have taken a patch of
material and secured it to an arm or leg with elastic wrap to see if
this was the case. If she had no issues with liners before this can be
ruled out.
My only thought is to slightly release the valve to relieve the pulling
sensation when sitting for a long time. When standing reseat the limb by
pressing on the valve. It sounds like you had a good fitting though.
Hope that helps,
-------------------------------------------
All over? If it was just at the seal and below I'd say it was the
negative pressure. Also sometimes I've had pt.'s leave the distal end
inverted prior to donning which can create an air pocket and pull
blisters distally.
I've never heard of anyone having an allergic reaction to those liners.
Please share you responses as I use these liners a lot.
Thanks and good luck
--------------------------------------------
This has been experienced with some people when changing from
skin/suction to HSI (Hypobaric cushion/Suspension Interface - more
popularly as a
Liner) for those using a silicone/urethane. I see many patients from
out-of-state and have learned to instruct patients NOT to wear the new
prosthesis/liner on the drive home or for any length of time - using a
progressive wearing schedule based on our personal experience.
--------------------------------------------
End of responses.
Kristin Schafer, B.Sc. (Kin.), C.P. (c)
Rehabilitation Engineering
Sudbury Regional Hospital- Laurentian Site
41 Ramsey Lake Rd.
Sudbury, ON
P3E 5J1
(705) 523-7100 x3176
************************************************************************
The information contained in this e-mail and document(s) attached are for
the exclusive use of the addressee and may contain confidential, privileged
and non-disclosable information. If the recipient of this e-mail is not the
addressee, such recipient is strictly prohibited from reading, photocopying,
distributing or otherwise using this e-mail or its content in any way.
********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>
OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affiliations should be used in all communications.
Citation
Schafer, Kristin, “Responses to silicone liner,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/231934.
