Why can’t I just make these sockets myself?
Answer:
1. Many years have gone into perfecting our molds for consistent results at all levels and sizes of amputation.
2. In order to fit the variety of patients one would see in a typical facility you need 114 molds.
3. Our price is extremely reasonable.
4. If you need a custom socket or system we have it shipped to you the same day we get the order, if we receive the order by noon.
5. Our system the APOPPS® by FLO-TECH® is becoming so recognizable that physicians are asking for it by name.
6. If you provide a socket you make yourself when the Physician is expecting the APOPPS® (or a portion of it) your socket is misrepresenting our system.
7. Nearly every city in America has a prosthetist using our system. If he|she encounters a counterfeit socket or system he|she will contact us (and have done so) because they do not want a negative outcome resulting from a counterfeit socket or system to adversely affect the APOPPS® reputation and thereby their own reputation.
8. Finally, using the original APOPPS® by FLO-TECH® is the right thing to do. Please call if you have any questions or if you need help with an unusual or custom size.
Robert N. Brown, Sr., CPO(e), FAAOP
CEO|Research & Design FLO-TECH® O&P System, Inc.
After only 40 minutes there was quite a lot of drainage. The doctor ordered us to wait a day or two before retrying the FLO-TECH-TOR™. What can be done to make this a successful fitting?
ADDITIONAL INFORMATION: My patient, a diabetic, had an opening in the suture line and was a delayed healer. I decided to try the FLO-TECH-TOR™ with minimal pressure to try to promote healing. I heated the side opening panels to minimize pressure on the slightly ‘dog eared’ residuum (amputated limb).
Answer:
The drainage you saw initially is probably a ‘good thing’. When there are trapped fluids, and total contact support, the fluids will be evacuated from the residuum. The fluids will seek the path of least resistance and since this particular patient had an opening in the suture line, the fluids drained from the opening first. As the wound is covered in the FLO-TECH-TOR™, and total contact is maintained, the opening in the suture line will close and fluids will be evacuated into the normal circulatory and lymphatic system.
It is a good idea to remove the FLO-TECH-TOR™ several times a day until the wound closes. The inner sock can stay in place, while the pad and the distal portion of the outer sock are examined, wash the pad and squeeze it dry (do not wring), put a clean dry sock over the reticulated distal pad and reapply the FLO-TECH-TOR™ . Each time you remove the outer sock compare it to the last time to see if the drainage is subsiding.
You will see the drainage dissipate rapidly even with very minimal contact from the FLO-TECH-TOR™ . As healing occurs the bands and strap can be tightened a little in order to compensate for shrinkage and increased tissue tolerance.
Robert N. Brown, Sr., CPO(e), FAAOP
CEO|Research & Design FLO-TECH® O&P System, Inc.
The VCSPS™ broke after a few weeks use. What caused this?
Answer:
HISTORY: Upon questioning I learned that the distal strap was secured in a manner inconsistent with my recommendations. That is; it was wrapped around itself and tightened each day as distal shrinkage occurred, causing the anterior portion of the VCSPS™ to crack.
SOLUTION: The distal strap on the VCSPS™, APOPPS® preparatory socket, should be wrapped around the anterior portion of the UFOS™ (Universal Frame Outer Socket). This allows the strap to pull the posterior portion of the prep socket, ONLY, toward the anterior portion thereby engaging the posterior slots designed to accommodate distal AP reduction.
Robert N. Brown, Sr., CPO(e), FAAOP
CEO|Research & Design FLO-TECH® O&P System, Inc.
Pain has been a problem for the first several patients that I have used the trans tibial APOPPS® with. They have not been able to bear much weight despite use of oral and parenteral narcotics. Any hints?
Answer:
When a patient is fitted with the APOPPS® – FLO-TECH-TOR™ (postoperative preparatory socket) they should wear it gently snug (almost loose) for 24 hours then snug for another 24 hours. Once you are considering weight bearing (after 48 hours) ALL STRAPS AND BANDS SHOULD BE TIGHTENED and a simple test should be initiated. TEST: Gently push up on the distal socket. If the patient is in pain their tolerance level is lower than average and they may need to wait another 24 hours. This method of testing should be used until the patient is relatively pain free, usually up to 7 days after initial application of the FLO-TECH-TOR™ . After the test RETURN ALL STRAPS AND BANDS to their rest position (loose enough to slide approximately two fingers inside).
Once weight bearing is initiated gradual introduction to weight bearing is a good idea. The following plan may be right for you and your patients:
1. Ambulation attempts must be supervised. The prosthesis should make foot contact ONLY with the floor (not much weight bearing) and the gait should be smooth with good posture (remember to tighten all straps before weight bearing and loosen after).
2. At the end of the first session (and all subsequent sessions) check for pressure (sock marks should be evenly distributed over all contact areas in the lower socket) and look for drainage or wound deprivation. There should be none but if there is back off a bit, but maintain use of the socket for non-weight bearing. Resume efforts at weight bearing at a later date.
3. If all is well after the initial session begin slight increases in the amount of weight applied to the floor through the socket, pylon and foot. It is a good idea to use 10% of weight until the checkout is clear two consecutive days.
4. Then progress to 20% and then 30% and so on (continuing to do post ambulation checks) until your patient is ready for application of the VCSPS™ low profile ‘Prep’ socket which allows the patient to bend their knee for sitting comfort.
5. Your patient should now be ready for monitored independent ambulation.
I hope this answer resolves your concerns with early ambulation pain. Robert N. Brown, Sr., CPO(e), FAAOP
CEO|Research & Design FLO-TECH® O&P System, Inc.
We just discussed, by telephone, the problem of pressure ulcers over the tibial tubercle that I’ve had with several patients using the post op rigid orthosis. Your suggestion was to make sure the mid patellar tendon strap has a finger-breadth of looseness while the patient is at rest and to tighten the strap while ambulating. Thanks for your suggestion. – Pamela Davis, MD
Answer:
Upon questioning Dr. Davis further I learned the root of the problem was twofold.
1. The mid patella tendon (MPT) strap was being tightened upon initial application of the FLO-TECH-TOR™ (post op rigid orthosis [prosthesis]) and being maintained in this tightened state throughout the patients’ rehabilitation. The result is constriction, which can go unnoticed if the distal band is also secured in a tight manner or in most cases, excessive tightness of the MPT strap, simply pushes the socket off the patient shifting the MPT socket modification distally to a point where it will result in pressure on the Tibial Tubercle.
2. The patients were ambulating in parallel bars or a walker without the use of a pylon or foot. This also contributes to distal migration of the socket as gravity will pull on the socket and have no resistance from a foot and pylon. The use of a foot and pylon, in most cases, will augment healing by preventing distal migration, keeping weight bearing areas in designated anatomic contact areas and it will also maintain distal contact allowing the socket to act as a gentle pump removing fluids as the patient ambulates.
3. The thickness of the distal pad may be excessive; pushing the socket off, and thus causing trans tibial pressure.
So the solution is: When at rest the MPT strap must be loosened enough to slip 1 finger for large adult testers and 2 fingers for smaller adults. However upon standing with a weight bearing pylon and foot system (UFOS™) all straps and bands must be tightened. The MPT strap should be tightened to the point where the elastic (in older model straps) is completely stretched out and the distal pad must be correct – 1”, 2”, or 3”, NOT all pads all the time!
Upon completion of ambulation ALL patients should have the residuum examined for problems associated with weight bearing. When the socket is reapplied, for a patient returning to rest, the straps must be loosened.
Thank you for your question Dr. Pamela Davis! Robert N. Brown, Sr., CPO(e), FAAOP CEO|Research & Design FLO-TECH® O&P System, Inc.
It seems the sockets are bigger, circumferentially, than what I expected when I ordered. – Several Practitioners have relayed this
Answer:
All APOPPS® sockets are sized off of the FLO-TECH-TOR™ distal circumference. The FLO-TECH-TOR™ is formed ½” over the printed circumference. Sockets shrink as much as ½” in length and ½” in circumference from the MPT to the distal end. FLO-TECH-TOR™ sockets SHOULD NOT OVERLAP WHEN FIRST APPLIED TO THE PATIENT. The bands maintain total contact.
Solution #1, If the patient’s measurement over bandages and sock allowance, appears to be available in two sizes, PICK THE SMALLER SIZE.
#2, If the patient is measured prior to amputation, over skin, ADD 2 INCHES, but select the smaller size socket if the measurements fall between two (2) sizes.
#3, If the patient’s measurements fall between 2 sizes, and you have NOT allowed for socks, CHOOSE THE LARGER SIZE (only if measurements fall between two (2) socket sizes).
Thanks! Robert N. Brown, Sr., CPO(e), FAAOP
CEO|Research & Design FLO-TECH® O&P System, Inc.
How do I select a trans tibial FLO-TECH-TOR™ that is the appropriate size?
Answer:
The residuum is almost always swelled beyond normal. Select a size which will fit best after swelling is diminished. The size is selected by measuring over bandages at the distal end. If the size is borderline, stay with the smaller size. The slots on each side of the residuum should NOT overlap at first. If they do, or if they come close to overlapping, pinching can result. If you select a size that is too large pockets of edema can result.
Thank you! Robert N. Brown, Sr., CPO(e), FAAOP CEO|Research & Design FLO-TECH® O&P System, Inc.
Sometimes small blisters appear distally. How can these be prevented?
Answer:
Be sure you have the proper thickness of distal pads and that the extension strap is snug, maintaining distal contact. Be sure it is not so tight as to create pressure sores. The MPT strap should be loose enough to place one finger under the strap whenever the patient is in rest, and the outer sock must be changed 2 times per day minimum.
Thank you! Robert N. Brown, Sr., CPO(e), FAAOP CEO|Research & Design FLO-TECH® O&P System, Inc.
The APOPPS® seems to be ‘Too Bulky.’ Why is it so bulky? – (Question asked by many FIRST TIME users of the APOPPS® system.)
Answer:
This comment has been made several times and is answered most effectively by measurements. At a workshop on postoperative care, given in early 2000, a prominent prosthetist applied a cast with pylon and foot in his|her ‘typical manner’ as training for the group. Immediately after the cast was removed I applied the APOPPS®. The comment was made that ‘It (the APOPPS®) seems bulky.’ I immediately measured both the cast and the APOPPS® to find the cast was 1 inch larger in circumference and ½” wider than the APOPPS®.
Its also important to remember that the APOPPS® ® accommodates shrinkage and high activity. Therefore, it will become less bulky as it is used. Casts on the other hand tend to go unchanged or even get larger as they are replaced because patients become more active (if all goes as planned) and prosthetists will sometimes add more material to deal with increased activity.
Thank you! Robert N. Brown, Sr., CPO(e), FAAOP CEO|Research & Design FLO-TECH® O&P System, Inc.
Right now I’m using pneumatic prosthesis for my patient. I would like to know if the FLO-TECH-TOR™ could replace it.
Answer
I assume by pneumatic you mean an Air-Limb™ or similar post-operative system. The APOPPS® is an ideal replacement for such systems because the reason pneumatic systems need to be considered for replacement is almost always their complexity. The APPOPS® is simple in its concepts, varying only slightly from standard prosthetic principles. The FLO-TECH-TOR™ (post-operative socket) and the VCSPS™ (preparatory socket) can be worn without the UFOS™, pylon & foot. Thereby maintaining the support and control of the amputation, while providing a break from the cumbersome hardware. The preparatory socket not only compensates for loss of volume circumferentially, it is adjustable in the AP and ML distally as well as proximally.
Thank you for your question,
Robert N. Brown, Sr., CPO(e), FAAOP
CEO|Research & Design FLO-TECH® O&P System, Inc.
Why can’t I just heat and push out the distal end of the FLO-TECH-TOR™-TF if the length measurement is close to allowable limits. – Reed Mueller, CP
ADDITIONAL INFORMATION: The patient was a referral from a new physician or one who was trying the APOPPS®, APOPPS® -TF or a portion of it, for the first time.
DISCUSSION: You can heat the socket and push it out. However, if you are finally getting a physician to try some portion of the APOPPS® or APOPPS® -TF, after many attempts to encourage him to do so, I don’t recommend testing the limits of the system. Give the APPOPS® and yourself, the best chance for success. You know that if you make a modification in plastic (polyethylene) it can sometimes not go as well as you would like. It may function well, but it could end up not looking as nice as you would like it to. If the doctor or the patient rejects the APOPPS®, after your attempt to stretch the limits of the system, you may not only lose the ability to recommend the APOPPS® in the future, indeed you may lose the doctor altogether.
Answer:
The best solution is a custom socket. The cost is minimal $75 to $85 per socket and the result is what you expect, every time, from an APOPPS®. You’ll be happy and your patient will be given the best chance for a successful rehabilitation.
Best of all, the physician will have a positive feeling about the APOPPS®. He|she may even remember that you were the one who brought this technology to his|her attention. My experience, with plaster systems over 30 years of post-op care, has been – if things go bad he|she will definitely remember you. If you are just trying to build a relationship you could lose this referral source; but, if you have a well-established relationship it shouldn’t hurt your future referrals.
You can select “Custom,” provide accurate measurements and we’ll make sure you have the best chance to build on your referral source relationships in the future.[/toggle
Thank you for your question,
Robert N. Brown, Sr., CPO(e), FAAOP
CEO|Research & Design FLO-TECH® O&P System, Inc.
Could you let me know what you guys feel is the correct length for an upper leg amputation? My friend is having a hard time getting the correct fit because his amputation was not done right. They took his leg off right at the knee. We’re trying to get info about lengths of amputations. Please let me know what you guys feel is the correct length. – Thank you Charlotte Roberts
Answer:
Charlotte:
There is no “correct” length per se. What a surgeon usually does is match factors (blood supply, occupation, chance for progressive disease, etc.) and tries to keep as much as possible. If the blood supply is good it is usually best to keep the knee. If not, any length above that and longer than 8” (from the seat bone to the end of the amputation) should provide a residuum (stump) which any qualified prosthetist can fit well. Look for a prosthetist credentialed by ABC (American Board for Certification of Prosthetists & Orthotists) with continuing education from the American Academy of Orthotists and Prosthetists. A knee disarticulation length amputation has some advantages: better leverage, healthier blood supply, easier to keep the limb on, solid footing (if the end can tolerate pressure) and etc. Some disadvantages are: it is difficult to get the knee center of the artificial knee located at the same point as the healthy knee, maintaining a good fit until all swelling and shrinkage is gone, making a definitive socket which can be applied and secured without belts and etc.
Good luck,
Robert N. Brown, Sr., CPO(e), FAAOP
CEO|Research & Design FLO-TECH® O&P System, Inc.
I’m doing my first AK FLO-TECH® IPOP on Tuesday. Applying the preparatory inner socket (FLO-TECH-TOR™) immediately following surgery. I’m also viewing the surgery for a refresher in that area. I will be adding the outer socket & following the preparatory in the Rehab located in the same building as us after her transfer (2-3 days likely). I spent my wonderful Easter organizing a protocol sheet for the nurses and therapists. This should be helpful as these healthcare members aren’t experienced with this system either. I have previously done fiberglass cast BK systems; this is quite different. I am in virgin territory here, so any advice or comments or experiences are welcomed. Thanks in advance.
Answer:
I just did a Workshop in Florida. The transfemoral went extremely well under ideal conditions (patient awake, etc.). One of the prosthetists had some suggestions as he had fit a number of the APOPPS® -TF systems. He says he applies the neoprene pelvic belt prior to surgery and leaves it on the patient through the surgery. When he applies the FLO-TECH-TOR™-TF after surgery he simply threads the belt through the hole in the neoprene. It sounded like a good step.
Other suggestions that are helpful: we (FLO-TECH®) leave extra material in all areas we can. It is sometimes helpful to check the socket over and customize any areas where you have preferences (like rolled anterior edge or lower trim lines, etc.). If you know your patient’s waist size (Silesian measurement) it is also a good idea to cut it to their size in advance. The belt has pre-sewn cut areas so you should be okay without re-stitching it. Use only the number of distal pads you need to fill the gap plus ½” to ¾”. Any more will tend to push the socket off the patient. We include protocol sheets with each socket. Did you find these helpful? If you need them in white you can down load them from our homepage at www.1800flo-tech.com. I would appreciate it if you would let me see what you put together for your protocol sheets if they are different than that which we use.
Thank you for selecting the APOPPS®-TF® by FLO-TECH® and I hope all goes as well for you as our goal is for every patient.
Robert N. Brown, Sr., CPO(e), FAAOP
CEO|Research & Design FLO-TECH® O&P System, Inc.
I’m a P&O student at La Trobe University and was wondering if you could give some more information on the FLO-TECH-TOR system, specifically in regards to: Any trials|studies undertaken that involve this system; the amount of volume compensation it can handle; whether it’s for long or short term use (ie – immediately post op, longer term problems with volume fluctuations or for the daily changes in volume experienced by most amputees); how much it costs.-
The short answer is The APOPPS® and APOPPS®-TF are available in 2 length plus custom and 11 different IS THIS AMOUNT CORRECT? sizes for Trans tibial and 3 different sizes for Transfemoral. All sockets must be ordered in Left or Right configuration. These sockets are the closest thing to a custom made socket in a prefabricated system there is.
All sockets not only handle, but, accommodate volume fluctuations in a range of approximately 4″ for the smaller sizes to 6” for the larger sockets. Each socket is fit (or should be) when the patient is at their largest and will allow additional swelling or edema (about 30% of the adjustment range) if necessary; but will close down smaller approximately 70% of the adjustment range as the amputation shrinks.
The APOPPS® FLO-TECH-TOR™ (and TF version) is used immediate post operatively or as soon as possible thereafter. When the patient is able to ambulate (about 48 hours after application of the FLO-TECH-TOR™ (or TF) socket the UFOS™ is applied right over it. The UFOS™ is removable and may be retained at the PT department. This system is called the Rehab System and is used for supervised ambulation ONLY.
When the patient is ready for independent ambulation the VCSPS™ is used in place of the FLO-TECH-TOR. The patient continues to use the UFOS™ portion of the APOPPS®. This system is called the Prep System and is used with for long-term prosthetic care. The patient can then be measured (when ready – swelling down or gone, etc.) for a custom preparatory for a longer term and to allow for continued shrinkage and atrophy. He|she can then be measured for a definitive socket. The patient retains all portions of the APOPPS® to use as they see fit: preparatory socket while sleeping (because many patients get up in the night and forget they have an amputation – the first step usually results in a fall, and possible injury, if the amputation is not covered), a shower or swimming leg or in cases of swelling or shrinkage a temporary retreat from their definitive.
The cost is about a third (33%) of the cost of conventional methods and a microscopic % of the cost of those patients not treated with anything (usually results in injury, swelling leading to delays in their rehab and potential revision surgery).
Our APOPPS® is also available in a Symes system and a Knee Disarticulation System, as well. Our Mission is to “Make the benefits of APOPPS® technology available to all new amputees.” Currently we estimate we are able to fit 100% of amputations of the lower extremities, if called upon to do so. I hope this is helpful in answering your questions.
Robert N. Brown, Sr., CPO(e) , FAAOP
CEO|Research & Design FLO-TECH® O&P System, Inc.
