V Liner Responses

V Liner Responses

Jonathan Reynik

8/6/2013

Dear List Members:
 
Here are the responses to my inquiry regarding the V liner:
 
Original Post:
 
I am writing to inquire whether anyone has experienced any unusual limb volume changes at the proximal edge of the Ossur V-Liner when fitting trans-tibial (Tt) patients. I'm currently working with two Tt patients with similar limb lengths, which puts the proximal edge of the silicone ring of the V-Liner just below the fibular head. Both patients are male, had different surgeons, one is early 20's the other late 40's, the younger is 2 years post-op whereas the older is nearly 1 year, and both became amputees as a result of a MVA.

I made a standard suction socket for each patient according to Ossur's recommendations, and yet after a month of daily use both patients lost significant volume at the proximal edge of the silicone ring. There is limited volume change at every other circumference measurement. I have a great deal of experience fitting Ossur liners and have not had any problems with any other liner. I suspect the proximity of the silicone ring to the fibular head is the cause but if so, why?

Responses:
 
I agree with you that the ring is reducing the area encircles. Sounds natural to me. As long as your other mx's are the same the suspension should remain the same. I don't see a problem. *The only concern I would have is if they are feeling increased numbness, burning, or tingling that may indicate bruising on the nerves below the fibula. Cosmetically when you measure them in the office you probably see the valley of the ring. I would guess that after a nights sleep being supine that the limb has no ring crease.
 
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I just fit my first Ossur V liner with their Unity vacuum this week. I don't have anything to share, but would be very interested in seeing the responses you get.
 
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You are saying these are passive suction sockets and not vacuum? my guess is that atrophy is somewhat limited in the suction/ elevated negative pressure environment which occurs only distal to these seals simply due to the vacuum/suction that limits the skin from pulling away from the wall of the socket. proximal to the seal you get the normally occurring atrophy/volume reduction that typically occurs with new amputees. That has always been my apprehension with these systems (along with the high cost of the interface itself). I use primarily vacuum systems and I prefer that to occur throughout the entire socket as opposed to just distal to the seal. The obvious drawback to these systems, however is the decreased ROM at the knee.
 
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The problem of constant volume changes is very common and frustrating; and as you pointed out costly in your time, your expenses, and the patients inconvenience or harm. Vacuum systems work best when the limb is mature, or managed so that the patients volume is stable. These issues are affected by the patients weight, water retention, previous socket containment systems used by the patient unknown to his or her new prosthetist, water retention, effects of new medication the patient is taking, so many issues. I have suggestions and some probably match your own. Some problems are caused by the idea that the patients self image depends on him/her getting a final definitive limb to show they have crossed an imaginary finish line. This would make a great case presentation but that does not help you or your patients today. I think in future cases you will avoid rings that fit close to a bony prominence since limb fluids fluctuate and or migrate. The new Evolution system like some other systems allow you to decide where to place the ring. I believe the TEC system was just to stabilize the limbs size, and offer suspension; I don't believe it was to reduce limb volume.
 
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Many thanks to those who responded. Of the four Tt sockets I have made to date with the V liner, only one has been successful. I suspect the X factor is a question of residual limb bone length, i.e., the silicone ring may need to be at least 2cm distal to the fibular head. Perhaps Ossur or someone with more experience with V liners can qualify this in a future posting.
 
Regarding the aforementioned patients - both have since been fit with Ossur locking liners. And not surprising to me, their residual limbs have begun to increase in volume exactly where the silicone ring was sitting.
 
Final note - I would be very interested to hear from anyone else's experiences fitting the V-liner.

 Thanks again and kind regards,
 
J. Reynik, LPO
 
 
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