Technique for Perforating a Prosthetic Liner to Expel Sweat

Introduction: Sweating andmoisture buildup are caused by the insulative nature of prosthetic interfacematerials increasing the temperature of the residual limb. Hence, heat and sweating in the socket are among the most frequently reported problems that reduce quality of life for persons with amputation. The purpose of this technical note was to describe a simple, inexpensive technique for perforating a silicone prosthetic liner to expel sweat and enhance use of a lower-limb prosthesis. Materials and Methods: A liner holder consisting of a towel and socks layered over a mandrel to mimic the distal liner shape was made to stabilize the liner during the perforation process.With the liner placed over the holder such that the exterior surface was exposed, a perforating roller was used to perforate the distal end of the liner. When the liner was inverted, the holes were visible all the way through to the inner surface of the liner. Results: Expulsion of sweat through the perforations was demonstrated by pouring water into the liner, folding the proximal, open end of the liner to create a seal, and forcing water droplets to escape the perforations with some resistance. Additional evidence that water escaped was seen by the wet patches that formed on the exterior fabric of the perforated liner after active wear. One user with amputation described sweat being pumped out of the perforated liner into the socket and in some cases out of the socket through the air relief valve of the vacuum pump. Another user with amputation indicated that the perforations did not damage the skin and reduced slippage of the liner with respect to the limb. Conclusions: Initial clinical experience with this technique suggested that expulsion of sweat occurred and user feedback indicated improved prosthesis use as a result. Current experience using this technique in clinical practice has been limited to silicone liners. The long-term effects of perforations on liner durability or limb health are not yet known.