Name of the Procedure:

Addition to Lower Extremity, Socket Insert, Multi-Durometer Symes (HCPCS Code: L5661)

Common Names: Multi-Durometer Socket Insert for Lower Limb Prosthetics, Symes Prosthetic Socket Insert

Summary

This procedure involves adding a specialized insert to a lower extremity prosthetic socket, specifically for a Symes amputation (ankle disarticulation). The multi-durometer insert uses materials with different hardness levels to improve comfort and function.

Purpose

The multi-durometer Symes socket insert aims to enhance the comfort and performance of lower limb prosthetics for amputees. It helps to provide better pressure distribution and reduce friction, which can prevent sores and discomfort.

Indications

• Patients with a Symes amputation (ankle disarticulation).
• Individuals experiencing discomfort, pressure sores, or poor fit with their current prosthetic socket.
• Amputees requiring enhanced shock absorption and flexibility in their prosthetic limbs.

Preparation

• No significant fasting or medication adjustments are typically needed.
• The patient may need to undergo a fitting assessment to ensure the correct size and type of insert.
• A review of the patient's current prosthetic limb and any specific complaints or issues.

Procedure Description

1. Assessment: The prosthetist evaluates the limb and current socket to determine the appropriate design and materials for the insert.
2. Molding: A mold of the residual limb may be taken to create a custom-fit insert.
3. Fabrication: The insert is constructed using multi-durometer materials, which vary in hardness to target different pressure points.
4. Fitting: Once fabricated, the insert is placed into the socket of the prosthetic limb.
5. Adjustment: The patient tries the insert, and adjustments are made to ensure an optimal fit.
6. Finalization: Any final refinements are completed, and the patient is instructed on how to use and care for the insert.

Tools/Equipment Used:

• Casting materials for molding
• Custom fabrication equipment for creating the insert
• Fitting tools for adjustments

Duration

The fitting and adjustment process generally takes 1-2 hours, though the entire procedure from initial assessment to final fitting can span several days or weeks.

Setting

This procedure is typically performed at a prosthetist’s office or a specialized prosthetic and orthotic clinic.

Personnel

• Certified Prosthetist/Orthotist (CPO)
• Prosthetic Technicians
• Physical Therapist (optional, for gait training post-fitting)

Risks and Complications

• Potential for initial discomfort as the limb adapts to the new insert.
• Risk of pressure sores if the fit is not optimal.
• Possible need for multiple adjustments.

Benefits

• Enhanced comfort and reduced friction in the prosthetic socket.
• Improved pressure distribution to prevent sores.
• Better shock absorption, leading to more natural movement and gait.

Recovery

• Patients typically can use their prosthetic limb immediately after fitting.
• Follow-up appointments may be necessary for adjustments.
• The patient should follow care instructions to maintain the insert's condition.

Alternatives

• Standard single-durometer inserts.
• Gel liners or other types of socket liners.
• Pros: May be more readily available and less expensive.
• Cons: Less personalized fit, may not provide the same level of comfort and function.

Patient Experience

During the procedure, the patient may experience mild discomfort during the molding and fitting processes. Afterward, adjustments may take some trial and error to achieve the best fit. Post-fitting, most patients report improved comfort and reduced issues with pressure sores. Pain management is usually minimal, with most discomfort managed through standard over-the-counter pain relief if necessary.