Comfort Gel Liners

[renardwc at ctrvax.Vanderbilt.Edu]

For those who had questions about the Comfort Gel liners, this might be
helpful: I pick mine up next week so maybe will gain some experience.


Wayne Renardson
------------------------

>From OANDP-L with permission of Greg Kidder <legsrus at infi.net>

>Joan Cestaro, C.P. at <joan at SHENTEL.NET> wrote:

We have been experiencing many Comfort gel liners (and Comfort plus
liners) that develop a strange imperfection. The best I can describe
this "breakdown" is that is appears as though a razor blade has made
many small slices into the gel in a 1" or 2" area.  We have many
patients experiencing this and the rep as Ossur has no suggestions or
knowledge of its cause. It was happening to other practitioners first
and now to me.

This breakdown of the liner ultimately causes breakdown of the patient's
skin. It doesn't appear to be developing in the same places all the
time. Sometimes it's distally, other times it is midway in the
liner---nothing consistent to help identify a rationale.

This breakdown sometimes happens after many months and we have been
associating and rationalizing it with age and wear and tear. Other times
it happens immediately (my patient has had hers for only 2 months) and
is luckily under warranty.

I have investigated the types of soaps (lotions, medications) used and
the possibility that these patients may be leaving the liner folded.
Speaking only for myself, I provide very good education to my patients
on care and maintenance. I have not yet found any correlations. On one
liner, we thought the antibiotic used for a patient's ulcer may have
been the culprit, but it doesn't explain the other dozen cases we've
seen over these last few months. Have others been experiencing this?
Anyone have suggestions or know the cause (apparently the manufacturer
doesn't!)?

Thanks in advance,
Joan Cestaro, C.P.
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Joan:

We have exactly the same problem...many patients have had comfort liners
in the past with no problems. I have replaced three liners this week
that have failed prematurely.

Greg Kidder C.P.O.
Kidder Orthopedic
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Dear members,

I have received a considerable number of replies from the list and
realize this is a pretty wide spread problem. It's at least nice to know
that I'm not alone! It sounds as though the problem is lack of total
contact and/or voids in the socket causing shear stresses on the liner.
This in turn causes the gel breakdown. And I certainly admit that I do
not follow the standard protocol that is recommended by the liner
manufacturers (most of them) stating reduction only with no build-ups on
the positive mold. I still relieve for the distal tib and fib head
standardly, at the very least. I do not agree that Practitioners should
modify based solely on prolonging the longevity of the liners. In my
most recent case of the gel breakdown, the lady is a 40+ year old,
amputated as a child. She is as a conically shaped as they come. So,
this theory certainly makes sense for this case. She was cast with the
Icecast machine, but there may certainly be distal voids r/t her shape.

Following is a post from a representative at Ossur who describes the
problem and the possible cure. I hope this helps all of those who
responded having this same problem. Good luck to everyone and thanks to
all who responded to my query!

Joan Cestaro, C.P.
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Ossur reply- from Mark Muller:

The slits are formed from the silicon pulling away from its self where
there is a void. This sometimes occurs in places where the socket has
been built up like distal tibia or fib head etc...What happens is when
there is a void in the socket the silicon migrates to fill that void and
pulls away from its self and separates. These slits should not be a
source of  breakdown on a residual limb unless there is excessive
pressure in that area.

How I solve this problem is with silicon putty in the area to fill the
void. Place a small piece of silicon putty or what ever putty you want
to use with a piece of cling film over it so it does not stick to your
liner. Then have the pt. stand or walk with the putty in place to pack
it out and fill the void. Remove the putty. Then replace the putty
with pelite that you form in the shape of the removed putty. You can
use two part silicon or any other soft product that doesn't pack out to
fill the void instead of pelite.

You want to give our pt. relief but not loose your total contact or
total surface bearing interface. If it is a total contact socket with
evenly distributed pressure, it should not occur. I'm not saying that
you don't have a total contact fit but those slits can happen in
situations with a void. It could also happen at the distal aspect of
the liner if the socket is pistoning during swing phase. This can occur
if the socket was not elongated during casting.

The silicon in the Comfort liner is very soft. That makes it very
comfortable but it also makes is susceptible to these stresses. You may
want to switch to a firmer silicon like in the Dermo liner. You can get
the Dermo silicon, with aloe, in the same profile as the Comfort liner.
So you can retro fit them.