Is it for everyone?
In our practice we have fitted numerous multi seal-in liners on patients with a high success rate. Recently we had a change of opinion based on the case mentioned below.
Our patient had a traumatic amputation due to a motorbike accident. He also had a few fractures in his femur, which created their own problems with alignment and prosthetic rotation during the walking cycle.
When I first saw the patient he was walking with crutches and, initially, I had no doubt that a multi seal-in liner would work for his first prosthesis, and casted him.
In my clinical evaluation of his stump everything was within normal range.
The patient has two internal fixated pins on the medial and lateral side of his residual limb in the area of the femoral condyles.
The residual limb had 5cm of loose flabby skin at the distal end of the stump.
The socket fitted well and he could immediately walk without crutches.
His leg started atrophying (shrinking) which is normal.
After a month, there was some discoloration of his distal end and he complained of some discomfort.
From here on a few refits were done, because of shrinkage and trying to solve the discoloration on the distal end. We tried more elongation and pushing the soft tissue back. Neither of these made any difference.
We decided to add a silicone distal cup. I wanted to add some volume and control the soft distal tissue. It had a positive effect in comfort but the discoloration stayed and did not disappear. As the patient is adiabetic, I knew that this would have long-term complications and had to be addressed.
We then decided to put him on an OSSUR Shuttle Lock Pin System, and all the problems disappeared. My conclusion is that I should have tried the Pin Shuttle Lock earlier to control the loose, unstable, soft tissue distally.
Suction sockets are not a good idea in cases likethis as the suction will keep on pulling and constricting the soft tissue as itis unstable and has no internal support.
The Great White, a Vagrant and a Prosthesis
I recently took my two teenage sons, Mark and Andrew, to the beach for a swim. I have a below-knee amputation and wear a prosthesis that doesn't like water - which means I am not completely mobile (I have to take it off and hop) when getting in and out of water.
So, we're at the beach. It's a beautiful day. I take off my prosthesis on the beach and gracefully hop down to the water for a swim. Within minutes of entering the water a chap comes sprinting frantically down the beach shouting "Shark! Shark!" The water empties itself of swimmers in a flash and there I am, left floundering around in the surf with a Great White Shark looking for a takeaway dinner.
By this time my caring and helpful sons have reached the railway line, which is about two kilometers away, and are pointing in my direction. They were either pointing at me - as I pulled myself up on one leg in knee-high surf, looking decidedly Rastafarian with green seaweed dreadlocks dangling from my head - or they were pointing at something far more ominous - like the distinctive triangular-shaped shark fin behind me in the surf. I hoped for the former.
By now every single beachgoer has congregated on the beach in front of me. They can't fathom why I haven't left the water with a ravenous Great White doing his rounds. Kids are pointing at me, people are gesturing frantically and taking lots of photographs. There is even a tour bus of Chinese travellers posting live internet video feeds of my daring escape from the Great White!
So there I am, fighting to find a solid foothold in the surf. The waves are grinding me into a swirl of seaweed and sand and, when I eventually manage to pull myself upright, like a vile and slimy apparition from the deep, adorned in a new summer seaweed line - the spectators see only one leg!
The crowd's unanimous jaw drops to the floor. Clunk! Children scream and hide their faces in their hands, they take more photos, the ice-cream guy stops ringing his bell, the sausage falls out of a young girl's hotdog as she squeezes it in fright and I even hear a marshmallow hit the sand, dropped by a redheaded kid.
Have you noticed that when there is a shark scare the beachgoers stay at least 10 metres from the water, just in case the shark launches a land-based attack? There I stood, swaying uneasily in the knee-high surf with only one leg (the other supposedly munched for lunch by the Great White) facing a large crowd of stunned beachgoers. I was tempted to say,"Draw on three!" but there were just too many of them and I still had to hop thirty meters to my prosthesis and towel.
I finally made it through the throng of paparazzi and finger pointers to my towel and said something very profound to my children that I cannot repeat in this article. It was their grins that got me.
I put my prosthesis back on, rounded up my brave and courageous children who were still chuckling to themselves and we proceeded to leave the beach.
Just before we reached the car park a vagrant, who had witnessed the whole event between sips of his favorite beverage said, "Hey mister, the shark must have felt sorry for you!"