Walking in a vacuumassisted socket shifts the stump fluid balance

Abstract

Gains in stump volume have been documented in trans-tibial amputees while walking in custom made under-sized, total surface-bearing, vacuum-assisted sockets (Board et al., 2001). These gains raised doubts as to whether the sockets were truly under-sized and concerns that using an over-sized socket with vacuum-assist could lead to swelling, resulting, in discomfort or pain. The purposes of the present study were to determine if: (a) walking in a vacuum-assisted socket causes the stump to retain or gain volume in excess of the available socket volume and (b) the resulting increase in stump volume with an over-sized socket causes discomfort, pain, and/or the skin to redden. The results of this study showed the stump retained or gained volume in excess of the available socket volume while walking in vacuum-assisted sockets of various sizes. The stump lost less volume than predicted, or gained volume, in under-sized sockets. It also gained more volume than predicted in over-sized sockets. No discomfort, pain, or skin reddening, resulting from the volume gain was reported by any of the subjects after walking in an over-sized socket. This change in fluid balance towards a net gain supports the findings by Board et al. (2001) that vacuum-assist ensures a good fit during the day in ambulatory trans-tibial traumatic amputees with mature stumps.

Pistoning assessment in lower limb prosthetic sockets

“…56 Above all, less pistoning may indicate a more natural gait and the amputee is more likely to feel like the prosthesis is a part of their body. 19,63,38 Different methods have been used to evaluate pistoning in lower limb prosthesis, both in static and dynamic positions (Table 3). To date, radiological methods have constituted the more popular methods of measuring the pistoning.…”

Systematic review of effects of current transtibial prosthetic socket designs—Part 2: Quantitative outcomes

“…The most frequent design was a crossover design (n = 9) [27][28][30][31][32][33][41][42][43], followed by five single-subject/case studies [34][35][38][39]44], four randomized crossover trials [13][14]21,29], and three case series [26,[46][47]. The remaining studies were repeated-measure design (n = 1) [45], randomized controlled trials (n = 2) [22,24], cross-sectional design (n = 2) [36][37], and prospective study (n = 1) [40] Table 1.…”

“…Five studies reported the effects of VAS and TSB sockets on residual limb volume, from which one study was classified as having robust evidence [13], one as having moderate evidence [21], and three as having weak evidence [35,42,47].…”

“…Weak evidence-In a crossover trial by Goswami et al (DBS 15), residual limb volume was measured after 18 min of walking using alginate casting and water-weighting techniques [42]. The results were compared with the available volume of the VAS socket (78 kPa pressure at the interface) to verify whether the residual limb retained or gained volume in excess of available socket volumes.…”

Elevated vacuum suspension preserves residual-limb skin health in people with lower-limb amputation: Randomized clinical trial

“…Both terms differentiate the suspension method from passive suction or valve systems. EVS sockets continue to grow in popularity on the basis of improved fit and function [5][6][7][8] through a reduction of pistoning [5,[9][10][11] and residual-limb volume management [5,[12][13]. A recent systematic review of EVS studies [14] identified only two peer-reviewed journal publication related to the effects of EVS on residual-limb physiology [5,15] and underscores the need for more evidence-based research in this underserved field.…”