Northwestern University Flexible Subischial Vacuum Socket for persons with transfemoral amputation-Part 1: Description of technique.
Stefania Fatone, Ryan Caldwell
PMID 28094686WHAT IT FOUND
A new flexible subischial vacuum socket technique was taught to 30 prosthetists. 28 of 30 transfemoral amputee patient models walked comfortably in the check socket, with little visual gait change versus their usual socket.
This is teaching feasibility, not proven benefit.
Key findings
01The subischial socket uses an undersized highly compressive silicone liner, a flexible inner socket, a shorter rigid outer socket, and a sealing sleeve to create vacuum suspension.
02In the pilot courses, 30 certified prosthetists and their patient models participated, and 28 of 30 patient models walked comfortably in the rigid check socket with little visual gait change compared with their regularly used socket.
03Participants reported improved understanding of subischial socket and vacuum technology, and most were confident they could fabricate the socket and anticipated using it in clinical practice.
STILL TO COME
How it was doneWhat they found
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What it does not show
This paper describes a socket technique and teaching workshops, not a controlled trial of patient outcomes. The walking result came from visual group review of split-frame videos, not from a controlled comparison. The sample was 30 certified prosthetists and their transfemoral amputee patient models, and the authors recommend the socket mainly for experienced, compliant amputees with well-healed residual limbs that have well-regulated volume. The technique has contraindications linked to vacuum suspension, including significant muscle bunching, deep longitudinal invaginations, silicone liner allergies, and non-compliance with clinical care. The paper says the work is preliminary and more definitive evaluation is needed. The authors note uncertainty about fall-related fracture risk with lower trim lines and call for future research.
Declared interests
The authors declared no potential conflicts of interest. The paper reports financial support from the US Army Medical Research and Materiel Command, Fort Detrick, Maryland, as the awarding and administering acquisition office.
The easy way to misread this
Do not read 28 of 30 patient models walking comfortably as proof that the socket improves function, comfort, or safety. The paper reports a teaching pilot with visual gait review, not a controlled outcome study.