Vacuum Suspension: Effects on Tissue Oxygenation, Activity and Fit

• Limb volume at 3 weeks
• Transcutaneous oxygen tension (tcpO2) levels at 0 weeks
• Pistoning at 3 weeks
• Step counts between weeks 3 and 4

The fit of the residual limb within a prosthetic socket is a primary concern for many amputees. A poor fit can lead to skin irritation, tissue breakdown, and pain. Further, amputees with diabetes or vascular dysfunction often have difficulty maintaining healthy residual limb tissue; a condition that could be mitigated by the application of negative pressure (i.e., vacuum suspension). The aim of this research is to characterize the residual limb response to a vacuum suspension system and to measure prosthetic performance in comparison to a typical suction suspension system.

The proposed research plan involves two sets of human subject experiments: (1) prospective, randomized cross-over study to quantify performance of a vacuum suspension system as compared to a total surface bearing suction socket in terms of pistoning, maintaining limb volume, step counts, and subjective measures of fit and (2) measurement of transcutaneous oxygen tension as a function of vacuum pressure.

A proper fitting prosthetic socket provides the amputee with a comfortable system allowing them to pursue many of their desired vocational and recreational goals. Unfortunately, many amputees live with an ill-fitting socket and can experience limb pistoning within the socket, which in turn may result in skin irritation, tissue breakdown, discomfort, and a reduction in activity. One of the key factors affecting fit is intraday residual limb volume changes. For an amputee with dysvascular conditions, the implications of a poor fitting socket are exacerbated by poor circulation, reduced healing potential and the compressive forces exerted by their prosthesis.

Vacuum suspension systems may have the potential to alleviate these conditions for healthy and dysvascular amputees. The purported benefits of vacuum suspension systems include, but are not limited to: improved suspension (reduction in the amount of pistoning), maintenance of limb volume throughout the day, and increased tissue oxygenation to the residual limb.

Our first objective is to characterize performance, as related to socket fit, of a vacuum suspension system using objective and subjective measures. We will do this by conducting a within-subject experiment to measure pistoning in three dimensions while walking, overall and regional changes in limb volume before and after a thirty-minute treadmill walk, mobility (step counts) and the perception of socket fit (questionnaire) as a function of prosthetic prescription (vacuum suspension system vs. total surface bearing suction socket).

Our second objective is to determine the effect of pressures within a prosthetic socket on residual limb transcutaneous oxygen tension (tcpO2) levels. We will conduct laboratory-based, in situ testing to determine how the transcutaneous oxygen tension levels, at six sites on the residual limb, respond to pressures simulating those within a vacuum suspension system and a total surface bearing suction socket.

The proposed research will allow us to understand how suspension systems influence prosthetic socket fit and residual limb tissue health and to formulate a knowledge base on two suspension systems providing prosthetists and clinicians the objective data to make better prescription decisions. In addition, the methods utilized in this study (e.g., a residual limb limb volume scanner and assessing dynamic pistoning) can be used to study current and novel suspension systems, liners, and prosthetic socket designs to provide a standard for comparison.

• Amputation
• Diabetes
• Leg Injuries
• Traumatic Amputations

• Device: Total Surface Bearing Suction Socket
  Current clinical practice
• Device: Vacuum assisted socket system
  Novel socket system

• Active Comparator: 1
  Current clinical practice
  Intervention: Device: Total Surface Bearing Suction Socket
• Experimental: 2
  Novel socket system
  Intervention: Device: Vacuum assisted socket system

Inclusion Criteria:

• Be over 18 years of age and less than 70 years of age
• Have been fit with a prosthesis and have used a prosthesis for at least one year
• Wear the prosthesis at least 6 hours per day and be moderately active
• Ambulate without upper extremity aids
• Able to walk at a steady pace for at least 30 minutes on a treadmill
• Have a history of no falls within the previous 6 months
• Be cognitively intact so as to understand the research protocols in which they are participating

Exclusion Criteria:

• The etiology of amputation was a tumor and there is an active tumor or treatment of tumor
• They have a significant lower extremity pain condition, musculoskeletal disorder, or neurological deficit that would interfere with their gait pattern
• Their residual limb is ulcerated