Elevated Vacuum Suspension

Comprehensive insight into prosthetic suspension and volume management

What is elevated vacuum

• Past/present of suspension systems• Total contact vs PTB• Knee sleeve• Why not just pin suspension?• Fitting basics of elevated vacuum• Swing/stance…………positive/negative

Potential issues with pin suspension

• History of Pin• Swing/stance• Volumetric issues• Pistoning• Shear force vs liner matrix• Benefits

Suction vs. Elevated Vacuum

• Benefits of elevated vacuum in comparison

• Mm/Hg differences• How can I tell which is which?

Indications for Elevated Vacuum

• Functional level• UE mobility/dexterity• Compliance

Contraindications

• Unmanaged medical status• Poor compliance• Dialysis patients

Elevated Vacuum PumpsMechanical Electronic

• User activated• Weight activated

Interfaces

• Polyurethane lines (PUR)• Silicone lines• Thermoplastic Elastomer liners (TPE)• Skin fit

Cold Flow Thermodynamics of PUR

• Stress ball• Total contact• Vascular benefits

Which pump is best?

• Dynamic pumps have been shown clinically to provide superior outcomes.

Casting and Modifying • Vacuum Casting• ROM considerations• Total contact modifications• What about bony prominences?• Distal reduction

Fitting/alignment protocols

• Initial contact/heel compression• Vertical compression at stance• Are the hips level?• Torsion• What to look for…

Volume ManagementVacuum/Suction

• Socks = not padding• Volumetric changes• Minimalist approach

to volume management

• Baby hats• TEC Spots

Pin Suspension

• Fitting socks• Shrinker• Volume changes during

activity• The Matrix factor

ALL LIMBS ARE NOT CREATED EQUAL

• Custom liners• SPOTS

Sounds perfect but………..

• Characteristics which can cause problems• Lack of total contact (hyperplasia) • How to check for total contact distal• Pump maintenance

When to call the prosthetist?

• Things that are alignment/mechanical related that are causing deviations

• Common issues– lack of suction– Socket discomfort

Mechanical System Comparison

• Knee sleeve vs no sleeve• Harmony vs Unity system

Future of vacuum

• High friction interfaces• Weight considerations• 3D printing?• Why plaster is superior to CAD/CAM• Pressure sensitive interfaces?

Questions

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