vacuum suspension sleeve preferences responses part 1

vacuum suspension sleeve preferences responses part 1

Marina Musicus

1/14/2015

Thank you to all who responded to my post last week. It seems that this is
quite a contentious subject! I know your answers have helped us create a
better protocol for vacuum suspension systems, and I hope some of the
answers here help you as well.

                    Marina Musicus, CP

Original Post:

Our company is fitting increasing numbers of vacuum assisted suspension BK
prostheses, and we are having significant problems with suspension sleeves
tearing.

We have tried covering the trimlines of prostheses with leather and using
pieces of old sleeves as sleeve protectors. We have also tried gaiters.
Nothing seems to slow the rate of sleeve failure. We have problems with
patients of all activity levels.

   Has anyone had success with suspension sleeves for elevated vacuum
sockets? I'd like to hear any advice from fellow clinicians prior to
conducting our own experiments with different manufacturers' products.



Responses

Try EZ trim on the brim and R&B medical sleeves



Speak with Brent Romine with OttoBock...he seems to be the most
knowledgeable when it comes to vacuum troubleshooting. I believe
incorporating a laminated sleeve protector is the best option.



I have been going almost exclusively vacuum for the past three years. My
biggest success has been the following tricks:

· Very low anterior trimlines. I will take my ML trimline just proximal
of the femoral condyles and cup in slightly, this helps protect the trims

· We have also done a lot of seal in systems with success.

· The best liners we have used are ossur TF seal in or TT derm seal in
with the flip down ring.

· As for suspension sleeves, I have always had the best success with
Ottobock Derma-proflex sleeves. They always seem to last the longest.



I make a double BKA socket fexible and a graphite socket. The flexible
socket I leave an inch and half longer from the proximal edge. this way
the sleeve never touches the hard socket.



I know we struggle with the same problem especially with bilateral
patients. We typically use the Ottobock DermaProflex which are okay for
most patients (Ossur Iceross seemed to tear and get holes very quickly) and
when they have them in stock use the new Streifeneder which many patients
like and are we just got our first shipment to try out R&B Medical
Distributors gel suspension sleeves. At least you can use your warranty
return when it is under 90 days with Ottobock.



Check your trim lines. May need to lower a bit. Also thickness or lack
there of is sooooo important. Try thinning lamination thru the proximal ML
starting at the level of the tibial plateau and decreasing thickness from
there. This method has worked for me and have increased life of sleeve two
fold.



I have had success with ottobock’s suspension sleeve. It's a bit stiff and
difficult to pull up but it is very tough.



 As an active, rock-climbing BK with an elevated vacuum setup; sleeves are
the weakest link. Using a gaiter and sleeve alone (even without any
climbing) a sleeve will last me about a month at best.
I use a laminated sleeve protector (with a slightly longer than socket
prox./ant. trimline) and it has just about tripled the life of my sleeves.
3 months is my current record with an Ottobock gaiter, sleeve & sleeve
protector.



In short, you have discovered the primary weak link associated with
elevated vacuum systems: Failure of the sealing sleeve. The secondary weak
link is, of course, the necessity of using both an inner liner and outer
sealing sleeve: reduced range of motion, and more stuff that can, and will,
fail.
One of my patient's, who is not the most active guy on the planet, by any
stretch of the imagination, goes through a sealing sleeve every 30 days, at
best. He is Worker's Comp so, while they grumble every time we ask for two
more liners and/or sealing sleeves, they do allow us to keep providing them.
In an effort to build a simpler, more durable, more practical system, I was
encouraged to see Ossur's new Unity system, which forms the seal within the
socket, instead of up on the thigh. This sounded great in theory, but after
8 months of working on new Unity sockets for several of my patients, I am
no closer to having converted them from their elevated vacuum sockets to
the Ossur system, even though we've had great help and support from Ossur
in trying to design and troubleshoot new sockets.
One thing for sure: My successful elevated vacuum patients will all tell
you that when it works, it's fantastic. When it doesn't, life sucks. There
is no in-between.
In my opinion, when someone comes up with a system that still allows the
vacuum to be spread over a large area, like the sealing sleeve does, yet is
not dependent on the durability of the fragile sealing material, we will
actually have a viable system to use and promote. Until then, however, I
would be careful who you put in one of these systems, unless your specific
goal is to make more money while never actually providing a useable,
serviceable, viable product.



Have you tried the IceFlex/ vacuum sleeve from Ossur. It has a really
durable cloth/gaiter like covering on mid sleeve aspect that interfaces
with TT/brim trimline. I've had fewer problems with this particular
design. Have patients demonstrate how they're donning their sleeves. If
they are too aggressive, you may want to opt for modifying their
suspension. Like Coyote, Vacuum, and sealed pin suspension. If all pts are
ripping their sleeves then you're not getting a real smooth edge on the
brim. So much for the weak link!



They all get holes
The limb logic sleeve with the silicone cuff helps to extend the life, but
they require more management then most patient want to deal with.

 I have been a long-time proponent for BK suction / vacuum suspension, but
as you know the sleeve is the weak link in the system, once the sleeve is
compromised, it loses almost all its benefits.
I think the wrong approach I see some manufacturers taking is to add more
and more reinforcement to the regions where the tears typically might
occur. This tends to add bulk and restricts knee movement.
As an amputee myself, I have never had a single sleeve, no matter what
brand or type, last more than a week without developing some small pin-hole
somewhere. This typically is caused from incidental contact with outside
objects or from kneeling, climbing, and especially activities like mountain
biking and off-road motorcycle trail riding.
What I learned a long time ago is to wear two thin, highly elastic,
non-reinforced sleeves (the ALPS easy sleeves seem to work very well for
me), then with some type of elastic-fabric compressive cover sleeve over
top on the outside. With two sleeves, both can be compromised, but by
slightly rotating one relative to the other, the holes in either sleeve
will be sealed by the other sleeve. With this set-up I am able to go
several months per pair this way, even with several off-road rides per
month on mountainous, rocky trails partially overgrown with harsh brush.



The only way we have found to significantly prolong the life of a sleeve
is laminating a removable shell over the socket/old sleeve.



I use the Otto Bock Derma Proflex sleeve on my vacuum patients.
I have found having extra felt or equal added around the brim during
lamination gives you a more rounded blunt edge at the trim line and can
help reduce holes in the sleeve. Also if you use a flexible inner socket
you might be able to lower the trim line on the rigid frame to reduce the
abrupt transition from the frame to the flexible socket. (this also helped
with some of my patients). Other patients are just hard on sleeves.