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Lower extremity care is provided for all levels of amputation, including partial foot, symes, below-knee, above-knee, hip-disarticulation, knee-disarticulation and hemi-pelvectomy amputees. Our goal is to build a comfortable prosthesis based on your goals and lifestyle no matter the level of your amputation.
The most critical component in all prosthetic designs is the socket. A prosthesis can have all the latest high-tech features and specialized components, but if the socket does not fit accurately and feel comfortable, the patient will not be as active as they’d like. Or the prosthesis will sit in the closet.
The socket is the critical interface between the amputee and the prosthesis.
Older, conventional sockets had a rigid shape that was uncomfortable—even painful— for the patient to wear. Years of research have led to a flexible, lightweight socket that is contoured to fit the bone, muscle, vascular and nerve structures of each patient’s residual limb. In 1992, John Sabolich created the patient Sabolich Socket, a true breakthrough design that provides both comfort and stability for the person who’s wearing it.
Scott Sabolich has taken this design to the next level. The socket design is proprietary to our clinic, and our prosthetists have been through years of training to be able to correctly fit the latest generation of Sabolich socket designs.
The below-the-knee socket has varying degrees of flexibility depending on each individual’s needs. To add stability, it fits into a lightweight composite frame. Some sockets feature fenestrated areas on the frame, producing flexible portions over bony prominences and muscle bellies, with the rest of the socket having a more firm quality. There are self-suspending suction sockets with molded silicone gel suspension sleeves.
The above-the-knee socket has varying degrees of flexibility depending on each individual’s needs. To add stability, it fits into a lightweight composite frame. Some sockets feature fenestrated areas on the frame, producing flexible portions over bony prominences and muscle bellies, with the rest of the socket having a more firm quality. There are self-suspending suction sockets with molded silicone gel suspension sleeves. Many of the advances seen in above-knee prosthetics are applied to our patients with hip-disarticulation or hemi-pelvectomy amputations. Although these sockets wrap around the entire pelvic area, they are lightweight, flexible and trimmed out enough to allow greater freedom of movement than previous designs.
Partial foot prostheses have also advanced in terms of design and materials. Today’s slipper-type designs are fabricated from silicone which simulates human subcutaneous tissue much more accurately than plastics or rubberized epoxy.
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Our upper extremity care includes finger, partial hand, hand, wrist disarticulation, below-elbow, above-elbow, shoulder-disarticulation, and forequarter amputees. Advances in electronics, micro-chip technology, specialized terminal devices, and lightweight, contoured sockets have brought dramatic improvements to upper extremity prosthetics. Our upper-extremity specialists are dedicated to helping you discover the combination of componentry that will best meet your needs.
The socket is the critical first component in all our upper extremity prosthetic designs. Each socket is custom contoured to fit the bone, muscle, vascular and nerve areas of the residual limb. The result is a socket that has total contact and even pressure with all the surfaces of the residual limb. That means greater comfort, increased muscle function, better suspension and greater range of motion.
The conventional or body-powered prosthesis uses a harness to suspend the arm and fastens around the patient’s upper torso. A cable extends from the harness to a mechanical hand, hook or elbow; exaggerated upper body movements activate the cable, which controls the prosthesis.
A much different approach is seen in the electrically-powered prosthesis where motors open and close the hand, flex and extend the elbow, or rotate the wrist. This type of prosthesis is often referred to as myoelectric. By contracting muscles in the residual limb, the patient activates the motor in the elbow, wrist or hand. The most advanced myoelectric arms have proportional control hands and flex wrists.
One exciting new technology allows the patient to connect the arm to their own computer and, using a special software program for technical troubleshooting, make minor adjustments on their prosthesis. It is also possible for the prosthetist to be involved by way of computer modem when more complex analysis and adjustments are necessary.
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Partial FeetPartial foot prosthetics have advanced in terms of design and materials. Today’s slipper-type designs are fabricated from silicone simulating human subcutaneous tissue much more accurately than plastics or rubberized epoxy. This is important because of the tremendous pressure that is applied to he ball of the partial-foot when the patient walks. The silicone both cushions the weight load deflecting pressure from the metatarsal bones. As discovered in socket design, exacting bone and muscle contouring on the partial foot prosthesis is critically important.
Silicone Polymers Realistic, flexible and comfortable prostheses are created from silicone polymers. A plaster cast allows for an exact three-dimensional match with wrinkles, lines, and veins. Final detailing such as hair, freckles, age spots, etc. is achieved by painting with 100% silicone paints.
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If your doctor approves, you should begin wrapping your residual limb with an ace bandage with a “figure eight” pattern. It is important not to wrap your residual limb too tightly above the end of the amputation because it will restrict circulation. The bandage should be removed and rewrapped several times each day, because it will become loose and fail to provide adequate support as the limb shrinks.
We do not recommend the use of a shrinker or reducer sock until the sutures are removed. Once the incision is healed, a shrinker sock is more convenient and helps further reduce the residual limb for prosthetic use. Even after you get your temporary prosthesis, you should use a shrinker when not wearing your artificial limb to keep swelling to a minimum. Some amputees continue to wear them throughout their lives, finding the support from a shrinker particularly comfortable at night.
A prepatory prosthesis, also called a temporary prosthesis, always comes first. This is because the residual limb will continue to shrink in size for at least three months following surgery, maybe as long as 12 months. That means that the fit of the socket portion of the prosthesis will require several modifications.
A temporary prosthesis is less sophisticated than the definitive prosthesis and won’t look as attractive. But it saves time and money and leads to a better fitting definitive prosthesis. It also gives the patient the opportunity to be more active and to begin accepting the prosthesis as part of their body.
Regardless of how eager a patient may be to move on to their definitive prosthesis, if there is any uncertainty about the fit of the socket, the prepatory stage should continue.
Creating a prosthesis begins with the prosthetist casting the residual limb so a socket can be designed. During casting, a wet, plaster of paris bandage is molded around the residual limb, allowed to harden, and then removed. From this model, a clear diagnostic test socket is made that will allow the prosthetist to literally see the contour, fit and alignment of the socket.
Once the residual limb has stabilized in size, you will be fitted for a definitive prosthesis. It’s important to understand that it will not last indefinitely. A prosthesis is fabricated from mechanical parts; these parts were out or sometimes break.
Generally, a prosthesis will last between two and five years, depending on the patient’s activity level. Children who wear a prosthesis must be refitted more frequently to accommodate for their continuous growth. Also, people who lose or gain a significant amount of weight will probably need a new socket.