Prosthetic - Skin Invagination - Responses

Prosthetic - Skin Invagination - Responses

Orializ Gonzalez

2/11/2016

Here are the responses I got for the skin Invagination. Thank you very much for all the suggestions. 
Try bulk silicone worked into the void. I had good but time takingsuccess closing a fish mouth using this method, on a foreman in AL. 12 hrs aday on his BK out in the heat. Also, you may consider Seal in - X liner, aswith it, you can slide sealing ring practically anywhere on the leg. Ring willalso work on any no-fabric outside liner.


I have had some success using SilPoxy to create customsilicone pads in seal-in liners.  Thisworked for a distal invagination and did stick to the liner.  Depending on how thick you would need and thestress/strain of rolling the liner it may not stick well on the sides of theliner, but may be worth investigation.  Iused vasoline to protect the skin, squirted the silicone in and had the patientdon.
There is a medical grade silicone putty that you can use tofill the invagination. The name slips my mind. Gary Hooks with Ottobock told me about it. She could place it in theinvaginated area before donning the liner. I apologize for not remembering thename, but you can probably ask your Ottobock rep to put you in touch with Gary.He's an elevated vacuum specialist with bock if you didn't already know.


There are distal end cups made by Silipos and Willow Woodthat you can get, that will conform to the residuum and fill the gaps when thepatient has an invagination. The seal in liner is usually a more cylindricalshape, so if the shape is more conical the silicone or gel caps do a nice job.


UCO. Quick -Sil.  Wrapstump and inject


You need to take a mould of her residual limb without anyliner which will give you an impression of the invagination. I like to useAlginate as it reveals so much definition but use whatever you feel comfortablewith. Then pour silicone into the invaginated area and any silicone with a lowshore value will work. Once cured, clean the silicone liner with acetone oralcohol and remove all of the chemical solution that Ossur adds. Then spreadsufficient silicone adhesive over the pad that you poured and roll the linerover the pad onto the mould. Some adhesive may squish out but that's ok, justwipe it off. Wait for the adhesive to cure overnight and you should be good.Good luck


The easiest but slightly inconvenient solution is a gob ofsilicone putty smooshed into the invagination to keep it filled in. Yes I saidgob and smooshed, LOL.


You can use Silicone 5 or 10 (durometer) from RENEW. This isa do-it-yourself injection molding silicone compound. I have mixed and pouredthe liquid into the liner or invaginated skin area, donned the liner and wait3-4 minutes for it to set. Each one is different and it’s difficult to controlthe process sometimes but it can work.


Depending on where the invagination is occurring and howlarge it is, it might be an option for you to use a system where the seal isseparate to the liner and therefore you can place the seal in Andrea where nogap is created during ambulatory.


We use a silicone puddy that you can buy in a block fromSPS.  <URL Redacted>. Inexpensive and if it works for your patient you could attempt to use a curingsilicone to make a more permanent shape. Smooth On is what we use the ecoflex-5 is durable yet soft and will alsobond to the silicone in the liner of a seal-in. Just make sure you get it rightit is a pain to change if it is not. 


 
Another thing to consider is whether the surgeon used amyodesis or myoplasty to secure the muscles. I have seen mature amputations where the muscle was not secured to thebone and this can dramatically change the distal shape of the limb when themuscle fibers contract.


You mighttry using Dragon Skin from smooth on. You can purchase a small quantitytrial size for $30.  If you laminate the material do not usefast set. I've used this material for custom inserts as well as pads. For a padI would also add 10% slacker to create a tacky feel to the siliconewhich will help keep it in position under her liner. 


 
One of the quick-sil kits works perfect to make what you'retalking about. A lot of my TF vacuum patients I instruct them to use A&Dskin ointment to fill in invaginations prior to donning their liner to preventblistering. Which does not sound like the problem you are having. PersonallyI've not had great luck with custom liners that accommodate invaginations fornumerous reasons, mostly vacuum TF related though. The quick-sil kit can bebought from PEL or SPS and is a quick easy solution.


Any 2 part silicone putty should work well to make a custompad to fill the area and should make a seal against the liner. I used it allthe time for making custom toe fillers and spacers. It cures quickly, grindsnicely and gives a nice impression. Cascade and SPS sell it and it is calledPediplast.   <URL Redacted>

Alumilite also sells a similar product called amazing moldputty.


 
You may want to lookinto custom Evolution liner with an Echo or Aura sealing sheath depending onsoft tissue consistency..They are an Ossur company and do a great job.


 
Depending on how proximal the invagination is, we have hadsuccess with making a custom silicone distal cup to address the invagination,then re-measuring over the distal cup for the seal in liner size.  Wayne Koniuk with Custom Silicone of SanFrancisco seems to have a fine recipe for this. Cell is (415) 806-2719.  Hope thishelps!