2. The APOPPS™ & APOPPS-TF™ by FLO-TECH® O&P Systems, Inc.
Robert N. Brown, Sr., CPO, FAAOP
CEO/Research, Design & Education

3. Applications in Obesity
Setup
Selection of Components & Materials
Trouble shooting

4. APOPPSTM Adjustable PostOperative, Protective & Preparatory System for prosthetic rehabilitation
TRANSTIBIAL SYSTEM:
The FLO-TECH-TOR™
Protective socket or an early (supervised) ambulatory socket
The VCSPS™
Protective, PSRD or Preparatory socket
The UFOS™
Universal Frame Outer Socket
Ambulatory outer socket for both the FLO-TECH-TOR™ and the VCSPS™

5. APOPPS-TM TRANSFEMORAL SYSTEM: The INNER SOCKET The OUTER SOCKET
FLO-TECH-TOR-TF™ (Protective), early (supervised) ambulatory or preparatory socket
The OUTER SOCKET
UFOS-TF™ (Universal Frame Outer Socket)
Ambulatory outer socket

6. APOPPSTM & APOPPS-TF™ Specifics for Obese Patients
Systems In Stock:
Transtibial
Adult 7” & 9” length
Transfemoral
Adult 12” length

7. APOPPS™ & APOPPS-TF™ Sizing
The largest TT socket in stock:
MPT circumference of 19” to 20”
Distal circumference of 16” to 22”
The largest TF socket in stock:
Ischial circumference of 30”
Distal circumference of 22” to 28”
Longer or larger requires custom system

8. CUSTOM ORDERS 131 custom sockets provided in 2003
An average of nearly custom sockets per week
Allow 3 lab days
Average shipping time days
If ordered before 12 noon
APOPS-KD™ (Knee Disarticulation)

9. Stock BB-d™ Pre-custom Definitive
Available in Transtibial & Transfemoral systems
Stock
Custom sizes

10. Stock BB-d™ Pre-custom Definitive
Adjusts circumferentially at all levels
AP adjustability at all levels
ML conforms to patient at all levels
5 stock sizes
2” carved distal end pad
Custom systems available

11. BB-d™ ORDERS Available in:
5 Transtibial & 3 Transfemoral Stock sizes in left & right configurations
Custom sizes
Custom strength
Based on weight & activity level
Non-ambulatory (polypropylene inner socket & Polyethylene outer socket)
Up to 500 lbs. (Acrylic resin, carbon & Kevlar inner socket & co-polypropylene outer socket)

12. CUSTOM ORDERS PROVIDED
Adult Transtibial sockets & systems
Adult Transfemoral sockets & systems
Adult Knee Disarticulation sockets & systems
Adult Symes sockets & systems

13. CUSTOM ORDERS AVAILABLE
Toddler, children & youth Transtibial & Transfemoral
Toddler, children, youth & Knee Disarticulation & Symes
Not your every day shapes, sizes and systems for adult, youth, children or toddlers

14. CUSTOM ORDERS PROVIDED
Odd shapes
Extremely long FLO-TECH-TOR 
MPT to distal end = 23 ½”
plus 1 ½” shrinkage & padding
plus thigh length and trim allowance of 12”
Total one piece forming 37”
Extremely large TF = 45” Ischial circumference

15. Applying the Socket Attachment Plate
Bottom portion of UFOS™ MUST be flat
If not; LIGHTLY sand with a disc sander to remove any protruding plastic
AT POINT(S) OF CONTACT ONLY

16. Other UFOS Trim Permitted
Suspension wings (A) on the proximal medial & lateral sides
Proximal posterior (B); if necessary
NEVER remove material from the distal sides (C)

17. The Socket Attachment Plate
The holes in the socket are oversized intentionally and line up with the holes in the Grace plate & the socket attachment plate
If not; carefully drill or cut away any interfering material & smooth as needed

18. Why Over Sized? Rotation – 7o to 10o A & P slide – 1/4”
To provide & permit
Rotation – 7o to 10o
A & P slide – 1/4”
M & L slide – 1/4”

19. COMPONENTS & OBESITY
Rating of a complete system is determined by the lowest rated component
The lower the activity level the higher most components are rated
Pylon components rated at 300 lbs with a socket unable to support 300 lbs. plus & an activity level exceeding these limitations negates intended rating

20. EXAMPLE:
Foresee – Weight & Activity Levels for Pyramid Systems & Delta Ankle
Low activity = 250 lbs
Moderate activity = 220 lbs.
High activity = 185 lbs.

21. COMPONENTS
Multiple manufacturers offer choices of: pylon, attachment components & knee units for patients who weigh 275 lbs or less.

22. COMPONENTS Rated to 300 Lbs.
Hosmer
The W.A.L.K. (Weight Activated Locking Knee) & S.A.F.K (Single Axis Friction Knee) units, Titanium #60794 & #60821
The S.A.L.K. (Single Axis Locking Knee) unit #60471
All Titanium & Stainless Steel pylon and attachment components in the series #60000

23. COMPONENTS Rated To 300 Lbs.
USMC
Some Titanium & Stainless Steel pylon and attachment components in the # series
Designated by AK and BK respectively
The Stainless Steel Knee unit #15226 and the Black Max Knee #P24000 series

24. COMPONENTS Rated To 300 Lbs.
Ohio Willow Wood
Magnum Heavy Duty System
Functional level 4 = 300 lbs.

25. COMPONENTS Rated to 350 Lbs.
USMC
Machined Titanium pylon and attachment components in the # series
The Black Max Short Knee & The ProSport® Titanium Knee in the # series

26. COMPONENTS Rated to 350 Lbs.
Ohio Willow Wood
Magnum Heavy Duty System
Functional level 1-3 = 350 lbs.

27. COMPONENTS Rated to 450 Lbs.
IPOS-Bauerfeind
X-tra Series

28. COMPONENTS Rated to 500 Lbs.
TiMED (Titanium Specialists in Prosthetics)
BK-500 (does not include foot)
GH-610 EX.HD EAR CONNECTOR
EH-503 TUBE CLAMP 34 mm (requires 2)
A mm CARBON TUBE
EH-509 EXTRA HD SACH FOOT INSERT
USE
HEAVY DUTY SACH FOOT
By Kingsley

29. APOPPS™ Follow Up Concerns
Sockets have specific warranties
Workmanship and initial quality
Thereafter:
FLO-TECH-TOR™ 30 days
VCSPS™ 90 days
UFOS™ 90 days
FLO-TECH-TOR-TF™ 90 days
UFOS-TF™ 90 days

30. Follow Up Concerns Hook and Pile Velcro® on the belts are slipping
SOLUTIONS:
Set belt to patients specifications & stitch all areas in place
You can remove and discard the double sided hook Velcro®

31. Follow Up Concerns
Patient seems unstable and one or more sockets demonstrate an unwanted medial-lateral motion
SOLUTIONS:
Practitioner may fine tune alignment
The toe out and the socket placement over the foot MUST be optimal to minimize unwanted motion

32. Solutions Continued ALIGNMENT SOLUTIONS:
Use equally rated offset components if necessary
Maintain alignment whenever removing or disassembling components
Use pre-custom definitive BB-d if necessary

33. Follow Up Concerns
Swelling is causing skin to protrude through the slots on either side of the FLO-TECH-TOR
SOLUTIONS:
Elevate the limb as often as is practical
Be sure the proper size is used
Apply a compressive sock, Ace wrap or liner to the residuum before socket application

34. SOLUTIONS Continued:
Add a thin polyethylene tongue to the affected area
Attach the tongue to medial and or lateral areas of the posterior section only

35. Follow Up Concerns Socket or system is difficult to don SOLUTIONS:
Apply inner socket & tighten straps and Bands
Apply a donning sleeve (nylon or parachute material) over the FLO-TECH-TOR, FLO-TECH-TOR-TF or VCSPS (straps, neoprene and all) AND
Open UFOS™ straps before attempting to insert the inner socket

36. Follow Up Concerns Socket or system is showing signs of stress
SOLUTIONS:
If FLO-TECH-TOR beyond warranty and patient will move to a new socket soon have patient avoid unsupported ambulation until the new socket is ready
If within warranty call for a Return Authorization number and replacement socket

37. Follow Up Concerns Sockets are rotating one inside the other
SOLUTIONS:
Be sure sockets are sized appropriately
Distal sockets are of tri-quad shape to prevent rotation
Call for assistance and possible return of socket or system

38. Follow Up Concerns
Patient is slipping up and down inside the socket upon heel contact and toe off
SOLUTIONS:
Most of this motion is designed into the FLO-TECH-TOR to prevent separation of incision upon early weight bearing and

39. SOLUTIONS Continued: Be sure socks are sized appropriately
Be sure all straps and bands are tightened before the UFOS™ is applied
Be sure the waist belt is secured properly
Application of the Prep Socket (VCSPS™) with other forms of suspension and distal AP closure should eliminate this concern “WHEN THE TIME IS RIGHT”

40. To make the benefits of APOPPS™ technology available to all amputees.
COMMITMENT
FLO-TECH® O&P Systems is here to assist you in any way we can; please call. Our staff can help with most: fitting, follow-up or adjustment issues.
Our Mission is:
To make the benefits of APOPPS™ technology available to all amputees.

41. COMMENTARY
Each APOPPS™ or BB-d™ prosthesis has the best opportunity for maximum comfort and success if the selection of components conforms to the patients needs and these components are set up, aligned and maintained in the most effective manner.

42. Questions Or
Shared Experiences