vacuum suspension sleeve preferences responses part 2

vacuum suspension sleeve preferences responses part 2

Marina Musicus

1/14/2015

Responses continued:

Your sockets are too thin at the proximal edge. To reduce the instance of
tearing suspension sleeves it helps to increase the thickness of the
laminate at the proximal trim line. Make sure the technician has a general
idea where the finished trim lines are and have them add a few layers of
Dacron felt about an inch wide, following the trim line. You could also
wrap a 4 or 5 inch band of felt around the whole proximal shell that
encompasses the trim lines. When finishing the socket, the thicker material
will allow the edge to be more rounded/less sharp. This works 100% of the
time.



The best sleeve durability I have found thus far is the OttoBock derma
Proflex sleeve. Best combination of skin comfort, flexibility /ROM and
durability. I fit quite a number of thermoplastic sockets which end up
having an edge thickness of around 4mm. The thermoplastic (modified PP) can
be polished to a nice radius and very soft, which is easy on the sleeves.
Low trim lines help too. When I do laminate, I typically use Synthex or
Coyote Composite with a double layer of nyglass in between and then use the
Fabtech EasyEdge to seal the edge fibres. A bit involved but it works well.
And in those cases of heavy use, or particularly prominent socket edges, I
will do a 2-3mm thick brim pad along the anterior 1/3 of the socket with
firm crepe or pelite.



I personally use the most recent Otto Bock harmony casting method which is
developed and taught mostly by Gary Hooks. With this method I have far
less sleeve failure due to the lower and more intimate trim lines. I
mostly use the Otto Bock Pro Flex sleeves, but I do use the Willow Wood
Limb Logic sleeves with certain patients. The use of a flexible inner
liner made with Otto Bock Thermolyn Supra Soft will also increase the life
of sleeves. On the tough cases I like to make a laminated sleeve protector
that comes about 1/4 above the trim lines on the anterior and ML, but
lower on the posterior. Gary Hooks is an outstanding resource with
elevated vacuum. Ask your local rep for more information on potential
courses, etc.



We have been fitting elevated vacuum sockets almost exclusively for about 8
years. We trim our socket low and keep them snug around the knee and brim.
We use gators and bock 454a7 over sleeves harmony. They work the best.



I have had significant experience fitting vacuum in both BK and AK
applications. In many cases, when patients are having issues with sleeves
not lasting, and it cannot be tied to a specific activity or situation, it
was because my trimlines were too high. This meant that the vacuum pump
was pulling high tension against the sleeve over the edges of the socket
and would think the area and it would be more prone to ripping. In almost
all cases, when I lowered the trimlines, it corrected most of the sleeve
problems.



Unity system from Ossur with seal in liner



i went to thermo plastic sockets and this has seemed to help a ton.



We put elastic banding on top of the socket similar to what you would use
with a cover to finish the top you can get it from PRS but we buy it in
black from JoAnn Fabric. The elastic has helped a lot but it will still
wear on the sleeve. We typically get between 2 months and 4 months out of a
sleeve more like 2 months with patients that are very active.
We either use the Otto Bock Proflex sleeve or the Willow wood limb logic
sleeve with sealing cuff. The cuff reduces knee flexion some but allows
for an extra layer of protection. You can also repair the limb logic sleeve
with silicone adhesive. Patient needs to be willing to do the repair as we
do not repair all the holes the patients get.



I personally have had best results with Otto Bock Derma Proflex sleeves

The toughest sleeve in the market right now is the OttoBock 453A3 or A4.
With or without a gaiter, they work very well and are quite robust. Make
sure you have at least 1/2 ounce Dacron embedded in the lamination at the
trim lines which allows for a very smooth, rounded finished edge.



I have the same problem. I've found that reflecting a sheath over the
socket trimline is as effective as anything, the idea being that if the
sleeve is allowed to travel rather than being fixed in place with vacuum as
the knee flexes it will not stress and tear (as quickly). Basically,
nothing can stop a sealing sleeve from tearing out sooner than it should
but I have settled on the Otto Bock 453A3 sleeves. Otto Bock has some
creative ideas on the subject related to the flexible socket design on
their elevated vacuum system. Ask Brent Romine or Gary Hooks.



Sleeves do not last long….

Using the under sleeve protector is good as well as some padding on the
proximal trim.

The Limblogic Sleeve seems to work the best. Patients seem to like the
Otto Bock DermaProflex sleeve more.



I would say the number one thing to look at is trimlines of the sockets and
how far the socket sticks out from the patient's leg. If the socket is
sticking out or too high and it protrudes during flexion it doesn't matter
what liners you use they will tear.

I like the Willow Wood liners that have the silicone gaiter. If you get a
hole, you simply rotate the silicone gaiter and the hole is sealed. the
otto bock proflex is preflexed and pretty durable too.



We have had success using the Willowwood sleeve. The key is to have the
patient slide the sleeve up while the leg is in a pre-flexed position, say
about 45 degrees. When they get a hole they can rotate the gaiter that
comes with it and as long as the holes in the sleeve and gaiter don’t line
up, they can still maintain vacuum. Another trick is to use a nylon as a
wick and have them reflect the nylon back over the top edge of the socket.
The nylon acts as a glide for the sleeve at the point where they get the
most friction.

Of course by using the SmartPuck you know that if a patient develops a
leak, it must be the sleeve, since that is the only point air can get in.

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