Transfemoral Amputation with Split-Thickness Skin Grafts Responses
Trevor Townsend
Description
Collection
Title:
Transfemoral Amputation with Split-Thickness Skin Grafts Responses
Creator:
Trevor Townsend
Date:
5/2/2013
Text:
My original question is below.
List,
I am looking for some input on the best interface and suspension for a
patient with Split-Thickness skin grafts on the distal two-thirds of his
residual limb. The skin tissue at the distal end is paper thin. Please
advise.
Trevor Townsend, CPO
Bakersfield, CA
Responses.
Obviously you don't want any shear abrasions to occur. Making that a #1
priority, if this is his first limb don't rush into anything but success.
Start his first socket using a sheath over the distal two thirds. If you
have one, or have one made make it a 2 inch finished top with silicone
beading circumferentially. The top third you can try enough silicone to make
a seal, but leave one inch smooth so it does not chaff the top of his thigh
when he moves.
****If the skin is closed now it should not weep. If it is fragile then
suction will draw out the fluid.
So using a sheath with SILVER should avoid total suction and this problem
from occurring.
Good luck,
Rick Feldman, CPO
Only one experience with this and used a TEC liner with success.
Brad van Lenthe C.P. (c)
ALPS makes a 9mm liner with the consists t thickness of 9mm all around. Keep
the proximal areas tighter and try a limb logic vacuum system as you can
easily control the vacuum strength. Use a very limited standing, weight
bearing and ambulating schedule initially (5 minutes) rest for (10) and only
wear the liner and prosthesis for a max of 30 minutes 3 times a day
increasing all times very slowly for the first week to 10 days. It can work.
Go slow. Good luck!
We have had success using the new Alps Winter Gel full suction liner. They
roll it on, spray with alcohol, and step in. We use an AK Lyn valve with it
and sometimes a power belt as a back up suspension. We have found this type
of gel to work best with skin grafts on AK and BK patients. Hope this helps.
Rachel Hartsell, CPO
Memphis, TN
Alps full suction liner with elevated vacuum
Wow, I would love to see the advise you get on this. I have only dealt with
split thickness in BKs and have had good success with the Harmony elevated
vacuum using the Harmony casting/modification system to a T.
Michael
Trevor. I don't think u can go wrong with ottobock urethane and vacuum. I
have had a ton of success with this. Call me if you have any questions.
605-232-0066 Jeff Boonstra CP
Refer the patient to a decent surgeon. I did and let him eval. He came back
and said that the patient should never have been provided with such as a
permanent
solution. He said it was a temp fix only. This justified a revision and a
successful fitting after 5 miserable and frustrating years with other
facilities. It's his call to make, really, and you have fewer headaches in
the long run. Just one additional consideration.
Tom Cutler
I would use the bock custom urethane liner.
Jim Rogers
List,
I am looking for some input on the best interface and suspension for a
patient with Split-Thickness skin grafts on the distal two-thirds of his
residual limb. The skin tissue at the distal end is paper thin. Please
advise.
Trevor Townsend, CPO
Bakersfield, CA
Responses.
Obviously you don't want any shear abrasions to occur. Making that a #1
priority, if this is his first limb don't rush into anything but success.
Start his first socket using a sheath over the distal two thirds. If you
have one, or have one made make it a 2 inch finished top with silicone
beading circumferentially. The top third you can try enough silicone to make
a seal, but leave one inch smooth so it does not chaff the top of his thigh
when he moves.
****If the skin is closed now it should not weep. If it is fragile then
suction will draw out the fluid.
So using a sheath with SILVER should avoid total suction and this problem
from occurring.
Good luck,
Rick Feldman, CPO
Only one experience with this and used a TEC liner with success.
Brad van Lenthe C.P. (c)
ALPS makes a 9mm liner with the consists t thickness of 9mm all around. Keep
the proximal areas tighter and try a limb logic vacuum system as you can
easily control the vacuum strength. Use a very limited standing, weight
bearing and ambulating schedule initially (5 minutes) rest for (10) and only
wear the liner and prosthesis for a max of 30 minutes 3 times a day
increasing all times very slowly for the first week to 10 days. It can work.
Go slow. Good luck!
We have had success using the new Alps Winter Gel full suction liner. They
roll it on, spray with alcohol, and step in. We use an AK Lyn valve with it
and sometimes a power belt as a back up suspension. We have found this type
of gel to work best with skin grafts on AK and BK patients. Hope this helps.
Rachel Hartsell, CPO
Memphis, TN
Alps full suction liner with elevated vacuum
Wow, I would love to see the advise you get on this. I have only dealt with
split thickness in BKs and have had good success with the Harmony elevated
vacuum using the Harmony casting/modification system to a T.
Michael
Trevor. I don't think u can go wrong with ottobock urethane and vacuum. I
have had a ton of success with this. Call me if you have any questions.
605-232-0066 Jeff Boonstra CP
Refer the patient to a decent surgeon. I did and let him eval. He came back
and said that the patient should never have been provided with such as a
permanent
solution. He said it was a temp fix only. This justified a revision and a
successful fitting after 5 miserable and frustrating years with other
facilities. It's his call to make, really, and you have fewer headaches in
the long run. Just one additional consideration.
Tom Cutler
I would use the bock custom urethane liner.
Jim Rogers
Citation
Trevor Townsend, “Transfemoral Amputation with Split-Thickness Skin Grafts Responses,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 27, 2024, https://library.drfop.org/items/show/235207.
