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GlideWear® Prosthetic Liner Patch Presentation of a New Intervention for the Management of Skin Breakdown for Amputees

Presenter Intro + Disclosures Charles W. Kuffel MSM, CPO, FAAOP is the President & Clinical Director at Arise Orthotics & Prosthetics. Kevin Hines CPO is an owner & certified prosthetist-orthotist at Arise Orthotics & Prosthetics.

Presenter Intro + Disclosures Charles & Kevin both serve as clinical consultants for Tamarack Habilitation Technologies. Jason Pawelsky is the Sales & Marketing Manager at Tamarack Habilitation Technologies with 8 years of O&P product development-related sales & marketing experience.

Webinar Agenda Discuss the skin care challenge faced by Prosthetists and Amputees Introduce friction management concept and its role in wound care Introduce GlideWear Prosthetic Liner Patch Present case studies Q&A Contact Information

The Prosthetist’s Dilemma Approx. 1.9 million amputees in the U.S. Over 65k LL amputations annually due to diabetes alone Annual prosthetic liner utilization estimated at over 200k units Skin integrity disruption is a constant struggle for the Prosthetist and rising amputee population – it is not isolated by diagnosis, geography, liner, or device type

Interface Design Concerns A recent survey of Prosthetists about the design of prostheses conducted on the OandP-L (n = 95) revealed: Nearly 50% concluded that the most important area for prosthetic device design improvement is on interface materials The distal tibia and fibular head ranked as most common areas of socket discomfort for transtibial amputees.

Got Pressure? Pressure reduction in at-risk areas is an essential component of skin tissue health and is the leading focus amongst clinicians. However, pressure isn’t the only consideration… Once a prosthetic socket is fabricated, both friction and moisture must also be appropriately managed.

The Impact of Friction & Shear on Human Soft Tissue Intrinsic Factors General health, nutrition, age, neuro-muscular and neuro-sensory status, metabolic status, etc. Global Factors Patient education, motivation, lifestyle, program follow-up, etc. Extrinsic factors Pressure Friction & Shear Microclimate Intrinsic and global factors are nearly uncontrollable. However, the extrinsic factors, through proper fabrication and materials selection and patient follow-up, can all be managed to improve skin tissue health, device compliance, and outcomes.

Extrinsic Factors - Summing It Up: FF Fs 1. 2. 3. 4. By addressing the extrinsic factors, 4 results will have to be met: Improvement of microclimate Redistribution of pressure loads Management of static and dynamic friction Minimization of shear forces in at-risk areas

Repetitive Loading During ambulation, load is applied to the skin, reaches a maximum and, in the unloading phase, incurs tensile stress caused by the weight of the prosthesis. This series of loading cycles occurs again, and again, and again… Virtually all repetitive loading has a “rub” (friction) component. When insufficiently addressed, skin breakdown occurs.

Repetitive Loading Let’s examine what this looks like clinically… Every ambulatory person has experience with this… It is an occasional irritant for “Mr. Blue” It causes significant discomfort and occasional breakdown for “Ms. Green” “Mr. Red” is unable to wear his leg until his wound heals – keeping him from living the active lifestyle he enjoys with his family & friends Let’s examine what this looks like clinically…

Tissue Trauma Examples

Conventional “Wisdom” Red skin = “Pressure Area” So, must reduce peak pressure… End of story. BUT REMEMBER! Reducing pressure decreases the clinical control that was originally desired Lost opportunity to enhance and extend function Labor intensive (costly)

How do we currently address friction and shear? Skin lubricants – lotions & gels Messy to apply Likely to spread beyond targeted area Hydrates skin when absorbed, increasing the coefficient of friction between skin and liner – making skin more susceptible to trauma Short term solution – needs frequent reapplication. Contraindicated for some liners

How do we currently address friction and shear? Moisture Management Liners Only addresses 1/3 of the equation Not widely used amongst amputees Skin-Drying Powders Messy to apply Limited duration of protection

The Friction Factor By introducing a low friction material at the interface of the device and skin, friction is virtually eliminated in targeted, at-risk areas. It’s important to mention that friction is important when it comes to supporting proper device fit & function– just not when it causes shearing and skin trauma.

What is GlideWear? Patented dual-ply low friction fabric technology Manufactured in Minneapolis, Minnesota by Tamarack Habilitation Technologies First commercialized in 2009 for use in wheelchair cushion covers and in 2013 for prosthetic liners GlideWear is a comfortable, versatile, long-lasting and highly effective shear management technology.

GlideWear® Prosthetic Liner Patch Indications for Use Indicated for nearly every amputee who experiences discomfort and skin breakdown from their prosthetic liner or socket. Critical Sites of Skin Breakdown include… Patella Popliteal Distal anterior tibia Fibular head Also recommended as a tool to prevent premature liner breakdown!

GlideWear® Prosthetic Liner Patch Features Easy to Use Available in two sizes. Place appropriately-sized GlideWear Patch against the targeted area before rolling the liner over the top.* Provides Targeted Shear Reduction Shearing occurs between the dual ply GlideWear fabric; not against the skin in at-risk areas. Extremely Durable Reuse daily and launder frequently for months of worry-free skin protection Tested through 100 wash/dry cycles and 180,000 rub cycles to ensure durability through long term use. *Do not apply directly over open wounds.

GlideWear® Prosthetic Liner Patch Benefits For Amputees Immediate improvement in comfort Better wound-healing environment Eliminates need for messy and ineffectual cream & powder use Protect liners from early wear-out Enjoy months of daily use with a single patch -> cost-effective! For Practitioners Less extensive socket recontouring = better fit and function Reduction of “early returns” due to nagging skin problems Reduced practitioner time on non-billable facility expense No reimbursement battles!

GlideWear® Prosthetic Liner Patch User Instructions Position the GlideWear Prosthetic Liner Patch over the affected area. Roll the liner over the GlideWear Patch to complete placement process. Use clean, dry patch daily to ensure lasting protection. Launder as needed.

GlideWear® Prosthetic Liner Patch Purchasing Options Choose from 2 size options: Small (2.5 in. x 4.75 in.) Suitable size for most users! USD $27 MSRP Large (4.5 in. x 7.5 in.) For larger limbs & coverage needs USD $34 MSRP Sold 2 patches (same size) per pack

Charlie, it was mentioned that this wound was not “infected” Charlie, it was mentioned that this wound was not “infected”. Is this the case?

GlideWear Tips GlideWear is not intended for placement directly against open wounds. Always follow standard wound cleaning & coverage procedures (as recommended by a licensed healthcare professional) to support a healthy wound-healing environment. To avoid recurrence of skin breakdown after healing, amputees should continue using the GlideWear Prosthetic Liner Patch daily to protect against future issues in at-risk areas.

Conclusions Skin breakdown in the amputee population can be addressed in numerous ways. Pressure, shear, and microclimate must all be managed to optimize device fit, comfort, and skin protection. GlideWear offers a simple, low-cost, and long-lasting solution for shear-related discomfort and breakdown for amputees.

Q&A + Contact Info GlideWear Prosthetic Liner Patch Questions/Comments? Please contact: To Order GlideWear Prosthetic Liner Patches, or receive Product Support please contact: Jason Pawelsky Sales & Marketing Manager JasonP@tamarackhti.com (866) 795-0057 toll-free (763) 795-0057 local www.glidewear.com/PLP Becker Orthopedic Customer Service mail@beckerorthopedic.net (800) 521-2192 toll-free (800) 923-2537 fax BeckerOrthopedic.com © 2014 Tamarack Habilitation Technologies, Inc. All Rights Reserved

CEU CREDITS To obtain CEU Credits, please refer back to the listing for this presentation on the Becker website and click the Test Questions link. After completing the Test Questions Form, please print the document for your records. You can then scan the document and upload it to us by selecting the Clinical/Technical Support button on the Becker website, or fax it to us at (800) 923-2537.