‘Donning’ a prosthesis refers to the application of a prosthetic device to the user’s body. ‘Doffing’ a prosthesis is the act of removing the prosthetic device. There are several ways for an amputee to put on a prosthesis, depending on the prosthetic design, the individual’s anatomy and the individual’s preference.
Push-In
For amputees with longer above knee residual limbs, some prefer to simply push the residual limb into the socket, usually using a lotion or powder. This approach is quick and simple; however, the extra tissue near the groin may not get contained in the socket and a bulge of flesh at the top of the socket may result.
Pull-In
To ensure all the necessary tissue is contained inside the suction socket, most above knee amputees prefer to pull-in using a donning device, such as a donning sock. This is more time consuming than the push-in approach; however, the result is a more effective socket fit.
Amputees can apply the prosthesis with or without the use of lotion. Lotion tends to facilitate and easier and less irritating donning process; however, some amputees do not like the feel of the lotion once the prosthesis is on. Donning with the use of lotion is referred to as a ‘wet’ fit; donning without lotion is referred to as a ‘dry’ fit.
Donning Supplies
· Clear Silicone Lotion (ALPS Silicone Lotion)
This lotion is used by many amputees preferring a ‘wet fit’. A very small amount of this lotion is massaged onto the residual limb and will remain there, un-dried, until the limb is washed. This lotion is excellent at reducing friction and facilitating easier donning. The downside of this lotion is that it is difficult to wash the silicone off the amputee’s hands after application and some amputees do not like the feel of a ‘wet fit’. Any type of lotion or powder can collect inside a prosthetic socket over time, which will require the amputee to periodically clean his or her prosthetic socket.
This lotion is used for both above knee and below knee prostheses and can be utilized with many different socket designs, such as suction or silicone liner pin locking systems.
· White lotion (Dri-Lite)
This white lotion is massaged onto the residual limb as a fluid, but dries into a powder. It is also excellent at facilitating easier donning and somewhat reduces skin friction. It is easier to wash off the hands after application, but can also collect inside the socket over time.
· Powder
Amputees who do not like applying a wet lotion to the residual limb opt for baby powder, which is sprinkled onto the residual limb. This has a similar end result as the white lotion, after the lotion has dried. This is an inexpensive and easy-to-locate option for many amputees; however, it can be messy to apply and also collects in the socket over time.
· Donning sock
This donning sock is usually used in conjunction with a lotion or powder and is designed for a suction socket fit, where there is no liner interface. The most successful donning socks are sewn from a parachute-type material and are cone or tube shaped, with two layers of fabric. The amputee places the residual limb inside one end of the sock while the other end of the sock is pulled through the socket and exits out the valve hole. The amputee then pulls at the end of the sock, which hangs out of the valve hole, and the sock ‘pulls’ the tissue of the residual limb into the socket. Once the residual limb is fully inside the socket, the entire donning sock is pulled through the valve hole. This device is excellent at encompassing difficult tissue and ensuring total contact. The material of the socket is very smooth and does not irritate skin.
Donning socks can be used in upper and lower extremity suction prostheses and come in a variety of styles and materials, such as parachute fabric or nylon stocking.
Amputees can also use an Ace Bandage to wrap around the residual limb, and pull through the suction valve hole. These bandages are easily available and economical; however, they tend to irritate the skin during the donning process.