As we mentioned previously, there is a wide range and variety of prosthetic liners. The manufacturers of these liners use different materials and as such have their own specific instructions on how to care for their product. This information should be given to you by your Prosthetist and is specific to your situation.
The following information covers the main points that are common to most liners however you should always follow the manufacturer’s instructions over what you read below.
Donning and Doffing
Prosthetic liners can have constant direct contact with the skin for several hours at a time. Making sure the liner is rolled on correctly and located in the correct position is vital to guarantee that the liner is functioning properly while you are walking.
Your skin should be clean and dry before donning a liner. This is an ideal time to inspect your stump condition. If you notice any wounds or damaged skin areas, you should consult your GP for medical advice.
To don the liner you need to turn the liner inside out so that the gel/silicon surface is on the outside. There are several ways of inverting and donning a liner. The photos below demonstrate one such example.
The photos above show putting your arm inside the liner and rolling the gel/silicon down over itself. Once mostly inverted, the liner can be gripped around the distal umbrella so as to form a shallow dish shape.
The photo above shows donning technique of the liner.
There are several important rules you need to follow during the donning process.
It is very important to position the pin (if you have a pin liner) with the line of the stump. Incorrectly positioned pin can lead to difficulty in inserting the pin into the lock.
The liner must be rolled onto the stump, not pulled up the stump as this will damage the liner or overstretch the skin.
You must make sure that there is no air inside the liner when donned and that the liner maintains direct contact with the skin as you are rolling it onto your stump.
If you are a transtibial amputee, we recommend that you bend your knee joint to approximately 20 degrees when rolling the liner over your knee. This provides more comfortable sensations whilst walking and sitting.
If you are a transfemoral amputee, we recommend that you straighten your hip joint as much as possible to provide unhindered range of motion at the hip.
The doffing technique is very simple, you just need to roll the liner back down your stump without overstretching or pulling.
As the liner fits intimately against your skin, it is very important to follow some hygienic procedures to maintain a healthy condition of both the skin and liner. The inner surface of the liner must be washed on a daily basis. Washing removes any bacteria, oils and sweat that are naturally excreted from the skin. The outer surface of the liner can be cleaned less frequently, usually when it has visible marks.
Liner manufacturers provide their own liquid soaps designed for liners. As an alternative, a pH neutral soap without fragrances (soaps for babies) can be used in the cleaning process.
Once you have washed the liner, the inner surface can be dried using a clean, soft cloth.
The photo above demonstrates the washing and drying process of the liner.
Once you have removed and cleaned your liner, it is important to make sure that the liner is not inverted and does not have wrinkles. In general the liner can easily be stored on a horizontal surface, away from heat sources, direct sunlight and aggressive chemicals. However some manufacturers have special requirements and provide their liners with a holder, stand or hook.
How Often to Replace
As a quite delicate material, gel/silicon naturally degrades over time and gradually becomes impregnated with contaminants. The lifespan of a liner depends on the physical activity, physiological features of the individual, hygienic procedures and the environment encountered. In general, according to our observations, active amputees need to replace their liners one or possibly two times a year. Common signs of wear and tear include microscopic cracks on the inner surface of the liner, hardening or discolouration of the gel/silicon and separation of the fabric outer layer from the inner layer. Your prosthetist will help in deciding when a liner needs replaced.
The photo above demonstrates the common signs of wear and tear.
Physiological Effects of Liners
There are several effects which are considered as a side effect of prosthetic liner use.
Sweating is a normal physiological process, regardless of whither we use a liner or a conventional socket using a sock interface. The only difference is that sweat impregnates socks and change their physical condition. A liner does not become impregnated with sweat and thus does not change its’ condition during the period of use. It is common to experience excessive sweating for the first few weeks when using a liner for the first time. In most cases, sweating reduces over the adaptation period.
As soon as the surface of the skin is covered, it does not engaged in thermoregulation. This happens with all prosthetic sockets regardless of whither a liner is used or not.
Due to the nature of the liner materials which are biologically neutral, an allergic response is a very rare occurrence. Most skin reactions are due to inconsistency in the hygiene procedure, local infections or the liner is over-worn and in need of replacement.