Suspension liners for leg amputees

I am your suspension liner.

I have to firmly suspend your prosthesis comfortably, keeping it attached to your stump, I must protect your skin and suture lines, keep things hygienic and odourless, control swelling and atrophy (shrinkage), caress skin grafts, control rotation, prevent pistoning and promote good blood circulation. Furthermore, I have to last at least a year because I am quite expensive.

As you can see the choice of a stump liner is more important than deciding what car to buy. The Porsche 911 and the humble Beetle will surely get you from point A to B, but the wrong stump liner can ruin a prosthesis and only get you from A to Xtreme frustration.

A mineral-oil based Alpha liner is good for sensitive skin but not so good for very active patients. (Picture 2)

There are so many different types of liners available in South Africa. You can get French, American, Icelandic, German and I am fairly sure even Korean stump liners. The materials used in a liner include silicone, silicone gel, mineral oil impregnated gel, aloe impregnated silicone and techno gel, just to mention a few. The various brand names are even more entertaining. Cool liner, Sports liner, Comfort liner, Spirit liner, Original liner, Profile liner, Pro liner, Simplicity liner and Dermo liner to mention a few.

Most manufacturers produce specific liners for specific purposes. For example, a special liner for a particular sport, or, a patient may need a special liner for a stump with delicate skin due to a skin graft, or a specific condition like diabetes, where pressure sores and abrasions have to be avoided at any cost.

Manufacturers all claim that their liners are the best for a specific task when, in fact, some are very good and some, well, not so good.
Your prosthetist should be able to give you sound advice in this respect, but there are certain criteria I personally like to see in most liners:

1) A liner should last at least a year under normal daily use. Enough said.

2) All liners should stabilise soft tissues, improve circulation, minimize stretching, and add comfort.

3) Liners should not be too soft. The common belief that a softer liner will be more comfortable is wrong! It may seem nice at the beginning but it just prolongs the period before complications set in.

The Iceross Seal-In Liner is another major breakthrough in liner technology. It is a dramatically different and innovative suction suspension liner. It offers great suspension without an attachment pin so it is ideal for long stumps. However, it is not suited for freshly amputated stumps that still have to atrophy (shrink).

Please remember that a liner can compensate for an ill-fitting socket only for a short while. The end result is either skin or liner breakdown. Please make sure that your suspension liner is activity-level rated and, most importantly, that it is correctly rated for your activity level.

The following websites have extensive background information on liners. After doing a quick search myself, I have listed them below in the order that I rate the websites, best ones first. Just search for: Ossur liners, Otto Bock liners or Ohio Willowood Liners. The most common complication with stump liners is a skin rash. Very few people are allergic to specific liner material. Usually it is the skin that is allergic to its own sweat (like a nappy rash). Your prosthetist can guide you as to which barrier creams to use, and how to keep your stump sterile and clean. Bear in mind that cysts and abrasions can still occur if the socket is too tight in a specific area, even if you are wearing a liner.

The TF Adapt liner from Otto Bock.
Another complication that can occur is a rash that forms where the liner ends. This happens because of surface tension that builds up between where the liner ends and the naked skin. It can be solved by putting a bit of Vaseline around the brim to break the tension, or the liner can be cut in a wave pattern to reduce its tunica effect.

Liner brim cut with a wave pattern.

If you are a very proactive amputee and you are experiencing problems with your liner, do not hesitate to ask your Prosthetist or search the internet for answers and ideas. Some websites are linked to local suppliers that can also provide you with some answers. Most importantly, you must remember that all liner-related problems have got solutions!

Columnist Photos