Preface by the Prosthetists

One of the basic materials used for manufacture of nearly all orthopaedic appliances is plaster-of-Paris (p.o.p.).

When an exact cast of parts of the body is needed, plaster-of-Paris powder or bandage is used to make a negative model. P.o.p. is then used for positive models which can be modified according to basic anatomical and biomechanical criteria which frequently determines the function and success of the orthopaedic device.

P.o.p. powder, though, is not available in many developing countries. Its import and transport costs greatly exceed the value of raw material. Additionally no one would be able to guarantee its condition for use after a sea journey of perhaps thousands of kilometres and into developing countries with climates of all types with heavy rainfalls and high humidity.

Somehow, therefore, the prosthetist must cope with this problem and accomplish his objectives even without p.o.p. if need be.

There is a possible solution, demonstrated by Mary Harnish, Shirati Leprosy Control Centre (S.L.C.C.), Shirati, Lake Victoria, Tanzania which achieves the manufacture of prostheses, by means of resin sockets laminated "directly" on to stumps without using p.o.p.

The original technique may appear strange to the expert and, indeed, has caused considerable problems during development of the technique as well as with obtaining the required functional result.

The "Tanzania Training Centre for Orthopaedic Technologists" (TATCOT) and an expert group were confronted for the first time in 1980 and 1982 respectively with this technology and they have managed to improve the fabrication technique as well as the functional result.

This manual describes the improved "Direct Socket Lamination Technique" (D.S.L.T.) which has been applied successfully in many cases. It should be pointed out that this procedure of using appropriate technology is not easier but rather more difficult to apply than the usual manufacturing method. It was not developed as a "primitive solution" for non-experts, not in order to push aside the traditional method whenever this could be applied but rather as solution when no p.o.p. is available.

This manual will hopefully supply solutions to specific professional problems in developing countries and the authors would be grateful, at any time, for further inquiries, criticism and hints.

We would like to thank Mr. Norman Jacobs for revising the draft manual and also the numerous colleagues whose suggestions proved very useful for the work.

Wieland Kaphingst
Sepp Heim