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clanrickarde

New Socket / seal in liner/suction socket

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After taking delivery of my first permanent socket back in the first week of May.....now in late August I require 12 plus ply socks to fill it by early to mid-afternoon. After a visit to the leg man Friday he told me he will put me in a seal in liner/suction socket set-up. I'll not need a suspension sleeve with that and as a result it should result in a lot more knee flex and comfort.

I'd like to hear from those of you with experience in a BK seal in liner suction socket. My limb is now well along in terms of its maturity at nearly nine months post Ertl. 99% of the dull ache I used to have at night while sleeping is gone....I no longer use a compression sock as it simply is not needed. No phantoms or sensations to speak of.

If you have comments or experience please chime in.

Thanks

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If you are still having significant volume fluctuations, I would be leary of a seal in liner. If you increase the size of limb you will not get into the socket, shrink and you will fall out. I have had mine for nearly 2 years and love it. As you point out, no outer sleeve so you indeed have greater knee flex. I carefully lub my seal in rings prior to use and have use a pair of liners for nearly 2 years. At this point the outer fabric is getting kind of worn.

Bill

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I tend to think that going forward the degree of shrinkage will be less than what I have seen in the last five months. The limb seems very stable at this point.

Is it not possible to add any socks for some shrinkage with this set-up?

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I've worn the seal-in liners for the past 3-4 years. I like it quite a lot. Bill is right about the flucuations though. I have had the leg fall off. Socks won't help hold the leg if you lose volume. You can only cover 2-3 of the 5 rings. If you lose volume at the distal end of your limb, it will lose suction and possibly fall off. This happened to me while walking down the concourse at the airport in San Juan, Puerto Rico. I didn't know what I was going to do. Not a very good feeling. I managed to get to my gate and took the leg and liner off to let my stump hang for bit in hopes that it would swell some. That worked and I was able to board the plane.

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Bill is right about the flucuations though. I have had the leg fall off. Socks won't help hold the leg if you lose volume. You can only cover 2-3 of the 5 rings.

Hi Neal

I'm a through knee so, I wouldn't get the volume fluctuations some of you guys get.

However, I've been told not to put the sock(s) over the rings, but to tuck it (them) underneath (the rings). Yes, of course you'll need to cut the end off the sock(s), but it does work.

:smile:

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I agree with Lizzie, I have been told not to attempt to use socks over any of the sealing rings. The solution that was recommended was to use a Sillipos sheath under the liner (directly on the limb) to fill out shrinkage. I thought I had a plenty thin Sillipos sheath, but it ended up way to thick. In my case a sheath of 2 to 3 mm would have been plenty, but I had no access to one to try it.

Bill

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I think the leg man feels I am very stable at this point....especially at the distal end. I pile on half socks on the bottom end. The top half of the distal end I view as being about as settled as it can get. The bone bridge is self evident in defining the top half of the distal end. Sure I can expect to still atrophy some degree of muscle tissue from the calf but I hope this socket will last a good eight months or so.

I am sure when he casts me he will undersize it just a bit. He did that with the first perm socket. He does not use the computer generated casting but uses the old sytle method.

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I agree with Lizzie, I have been told not to attempt to use socks over any of the sealing rings. The solution that was recommended was to use a Sillipos sheath under the liner (directly on the limb) to fill out shrinkage. I thought I had a plenty thin Sillipos sheath, but it ended up way to thick. In my case a sheath of 2 to 3 mm would have been plenty, but I had no access to one to try it.

Bill

I am not familiar with this sheath? Does it roll on directly over the bare residual limb with no sock ? I take it these Silipos sheaths come in several thickness levels from one or two millimeters?

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I got my check socket for this seal in set-up on 22 September. First time in the socket late in the afternoon. I was surprised at how extremely tight the fit was. Quite literally devastatingly tight. But having no experience I went home with the socket to try er out. Friday morning proved to be quite a trial getting into it due to the normal upsize in the limb overnight. It became clear that it was far too tight. Monday I called the prosthetist and went in late morning. He took a heat gun to the plastic socket ...softened it up and had me step in while it was soft so that it would conform.

I have gone the rest of the week with it and although easier to get into in the morning it still seems to tight. After all day in the set-up I get some redness along the tibia end and it is not near as comfortable by far as permanent socket number one and 14 ply of socks.

I plan to call on Monday and suggest I go in and have him size it via the melt method while I am large in the morning. My residual limb has an hour glass shape...large just below the knee tapering thin and than large at the bony ertl bridge. The leg man and I agree that that hourglass shape effects a natural locking mechanism for me. That being said I think I need to be sized large so that this set-up is optimally comfortable from the first minute in the morning. Being loose does not seem like it is going to be a problem for me.

I have the Ossur Iceross X-5 seal in liner. I hope it gets better because I will not buy a permanent version of this socket until I know it is at least as comfortable as the first permanent socket for 13-14 hours a day. I do love the great flexibility/range of movement in the knee.

Is it normal for the suction socket to be so unnervingly tight from the outset?

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Call me crazy, but I almost always ask for the first appointment of the day. This goes for all medical appts. I have worn the 5-seal liner for over three years now. It is a hard set-up to fit. It has to be tight without being too tight. If it isn't tight enough it will fall off later if you have any shrinkage. Your bulbous stump should be good. It can be made a little larger at the distal end and still have the security of narrowing in the middle. I do like it a lot since it does allow better freedom of movement in the knee. If you do anything very active you might want to add a sleeve for added protection.

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The liner kit came with a full contingent of proximal socks for the purpose of dealing with future shrinkage. I also have the roll on Silipos items suggested.

I can actually feel to much squeeze all along the front of the tibia from several inches above the end as well as too much in back. During my original phase of check sockets back in Jan/April ...the distal end was the offender as far as discomfort (seems typical for a lot of us)

I am sure I will get there with this one. I'd almost like a new casting done first thing in the morning without being encased in the socket at all.

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I have worn the seal in liner for the past 4 months. My first socket was the pin lock type and I was up to 30 ply of socks within 2 months. I hated the way the pin pulled on the end of my stump when I walked. The seal in liner is much more comfortable and feels lighter because of the greater area of suspension. You have to be able to tolerate total contact though and some people can't. Our Prosthetist made 6 trial sockets for my husband and he never could get comfortable in it so he is back in the pin lock socket. I was comfortable on the first try. My husband has a much more sensitive stump, especially along the tibia, and seems to prefer having some sock layers between the socket and his stump. I HATE socks and really like the fact that there is a top limit of about 5-8 ply that is recommended for the seal in liner. My Prosthetist uses an inner liner and is able to add material between the inner liner and the socket in order to keep the fit right for a longer period of time. Since this is only my second socket I expect to need a new one in the next 6-12 months. My goal is o get an elevated vacuum system for my next socket.

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Hi Kitkat: I see this is your first post. Welcome. You should go to the introductions tab and tell us a little about you.

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Hi All,

I too wear a suction socket and basically like it. In July when I was leading a tour in Viet Nam the socket did not fit was well as I would have liked and when I got home with lack of humidity it was even looser--I think I lost a bit of weight as I was in the middle of moving and somewhat overwhelmed. I too put on a sheathe and it seems to have solved the problem for now. I agree it feels really unsafe when I experience almost walking out of my socket.

Peace, Beth Marie

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