A prosthetic liner is the interface between your limb and your prosthesis, with the two primary functions of protecting your skin and aiding in the suspension of your prosthesis. While some individuals wear a sheath, or "liner-liner" between their liner and their skin, most individuals will wear a liner directly on the skin. Some individuals do not wear a liner at all, and this is perfectly acceptable too.
Because most liners make direct contact with the skin, and due to their gel-like and "sticky" materials, liners cannot be donned in the same manner as socks or shrinkers. To don your liner, first turn it inside out. While inside out, correctly orient the liner both vertically, often with the logo face up, and horizontally. This ensures your liner is correctly oriented for your socket. If you are wearing a liner with a pin, this orientation will make it easier for you to engage the lock in your socket. After orienting your liner, place your limb into the bottom of the liner. If there is an umbrella, pinch both sides to make sure that no air gets trapped between the end of your limb and the liner. Roll the liner onto your limb evenly, ensuring it is comfortable and snug with no wrinkles. Avoid pulling on the liner, especially at the top of the liner. Pulling on the top edge can create a tension that can cuase irritation that may result in skin breakdown. It's best to roll the liner completely on, then release the tension on the top edge by lifting the top edge all around your limb. This will reduce that top irritation that some people experience from the liners.
Liners come in a variety of materials and with varying features depending on the type of suspension that your prosthesis utilizes. The inside of a liner, which is worn directly on the skin, can be made from silicone, urethane, a hybrid of the two, and more. Different materials provide different levels of durability, comfort, and elasticity depending on your needs. You may need a more skin-friendly liner, or one that is more pliable, or you may not want a liner at all; your prosthetist will work closely with you to determine exactly what you want and need out of your liner, and ultimately, your prosthesis.
Liners also come with a variety of features dependent on the suspension system utilized by your prosthesis. A suspension system refers to how your limb is connected to your prosthesis. The most common suspension systems are suspension sleeves with suction systems, pin or locking systems, but many more exist and could be right for you. A well-suspended limb is easier to control, feels lighter and more comfortable, and reduces the risk of skin breakdown.
Suspension sleeve systems utilize a sleeve that lays over the socket, about midway up, and extends onto the thigh. Suspension sleeves remove the air within the socket, creating a strong but comfortable suction system that is easy to don and doff and provides ample stability. Suspension sleeve systems typically use cushion liners, but a hybrid system might also be a good option.
Suction systems involve active or passive expulsion of air. Traditional suction systems utilize a one-way valve that expels air as the individual loads the socket, removing all the air, and holding the entire limb in the socket. Vacuum systems use a component, pushed by the patient or that uses a pump, that actively removes air from the socket.
While a specific liner is typically not needed for suction systems, some liners have seals attached or that can be donned seperately in order to improve the range of motion at the knee becuase it may allow the transtibial patient to use the system without a knee sleeve. For inndividuals with Transfemoral, or above the knee, amputations, this is a common system to use suction with the added benefits of a liner for the skin.
Pin or locking systems require liners with a pin attached to the distal end, or bottom, of your liner. Your socket will be fabricated to have an entry point in the bottom which your pin will enter and lock into. Pin systems are a favorite among many prosthetic users for their ease of use, stability, and secure locking system. However, they can be susceptible to pistoning, or the feeling of a pull on the tissue of the limb. Pin systems utilize a botton or mechanism that is pushed to release the lock, and on rare occasions this component can become stuck. If you find yourself stuck in your prosthesis, add a small amount of water between your limb and your liner to help you slip out of it, then contact your prosthetist to inform them of the issue.
Your prosthetist will give you two liners; one to wear, and one to clean. Because most individuals wear their liner directly on their skin, it is important to clean it daily in order to prevent any skin issues. Follow the manufacturer's instructions; most liners should be hand washed and hung to dry. This will extend the life of your liner. Machine washing or drying is not recommended. Remember to check your skin for abrasions, redness that lasts over 15 minutes, or any areas of concern every time you remove your liner. Contact your prosthetist if you see any blisters or breakdown starting to have your prosthesis adjusted.
Transtibial (Below Knee) Rolling a Cushion Liner Over a Sheath, or Liner-liner
How to Properly Clean Your Liner
Transtibial (Below Knee) Donning Suction System Prosthesis with a Suspension Sleeve Over Socks and Cushion Liner
Transfemoral (Above Knee) Donning a Seal and Sock Over Pin or Locking Liner (Hybrid system)