KENYA STANDARD                                  DKS 2612 -2: 2:2017 
© KEBS 201 7 LOWER LIMB PROSTHESIS.  2  
 
 
 
 
Kenya Standard — Prosthesis — Specification  
 
Part 2: Lower Limb Prostheses  
 
 
 
 
 
 
 
 09 October  2017 - Edition  
 
 
 KENYA STANDARD                                  DKS 2612 -2: 2:2017 
© KEBS 201 7 LOWER LIMB PROSTHESIS.  3  
 
 
 
 
 
 
TECHNICAL COMMITTEE REPRESENTATION  
The following organizations were represented on the Technical Committee:  
 
1. Association for the Physically Disabled of Kenya  
2. Dokimos Construction Company.  
3. Ministry of Health  
4. National Council for Persons with Disabilities  
5. Kenya Medical Training College  
6. Kenya Society of Physiotherapists  
7. Kenyatta National Hos pital 
8. National Association for Orthopaedic Technologist in Kenya  
9. Isole Engineering Works  
10. Ministry of Lands Housing and Urban Development  
11. Association For Accessibility and Equality (AAFE)  
12. Action Network for the Disabled  
13. Skillpark Company  
14. Kenya Bureau of S tandards — Secretariat  
 
REVISION OF KENYA STANDARDS  
In order to keep abreast of progress in industry, Kenya Standards shall be regularly 
reviewed. Suggestions for improvements to published standards, addressed to the 
Managing Director, Kenya Bureau of Sta ndards, are welcome.  
 
 KENYA STANDARD                                  DKS 2612 -2: 2:2017 
© KEBS 201 7 LOWER LIMB PROSTHESIS.  4  
 
 
© Kenya Bureau of Standards, 2013  
Copyright.  Users are   reminded that by virtue of Section 25 of the Copyright Act, Cap. 12 of 2001 of the Laws of Kenya, cop yright 
subsists in all Kenya Standards and except as provided under Sec tion 26 of this Act, no Kenya Standard produced by Kenya 
Bureau of Standards may be reproduced, stored in a retrieval system in any form or transmitted by any means without prior 
permission in writing from the Managing Director.  
 
 
Foreword  
This part 2 of t he Kenya Standard has been prepared by the KEBS/TC 132 Assistive 
Products for persons with Disabilities Technical Committee and it is in accordance with 
the procedures of the Bureau.  
The Standard was found necessary in ensuring the quality of Lower limb pr ostheses 
either manufactured locally or imported into the country. This is only a guide to the 
manufacturers, fabricators, service providers and users of Lower limb prostheses.  
Lower limb prostheses are devices designed to fit missing part of the leg. They  must 
permit comfortable ambulation during gait minimizing the shift of the center of gravity of 
the body enhanced by a well -fitted socket and proper alignment.   
 
 KENYA STANDARD                                  DKS 2612 -2: 2:2017 
© KEBS 201 7 LOWER LIMB PROSTHESIS.  5 DRAFT KENYA STANDARDS  
Prostheses - Lower  limb Specifications  
1 Scope  
This part of Kenya Standard establishes a classification of assistive products, especially 
produced for persons who are either amputated or with congenital absence of the leg . 
This part of Kenya standard specifies requirements for Lower limb Prostheses including 
medical and Bio mechanical principles, materials, shape, workmanship, finishing, 
packaging, marking, cosmesis, components parts, accessories and performance of the 
Prostheses .  
Application  
Lower limb  Prostheses are used frequently on patients who have had Amputation of th e 
legs at various levels due to various causes,  especially due to accidents and diseases . 
The Prostheses are made and fitted according to levels of amputations. The 
considerations when choosing Prosthesis include the following:   
 Amputation  levels  
 Contour of the residual limb  
 Expected function of the prosthesis  
 Cognitive function of the patient  
 Occupation of the client  
 Hobbies interests of the client    
 Cosmetic importance of the prosthesis (Aesthetics)  
 Financial capacity of the client  
2. References  
The fol lowing documents were referred to during the preparation of this standard, from 
which sourc e we acknowledge with thanks: -  
 
1. "Getting an Artificial Leg Up" , Australian Broadcasting Corporation , 2000. 
Retrieved 11 February 2007.  
2. Physics: A First Course.  "Connections, designing a better prosthetic leg"  
3. "A Brief Review of the History of Amputations and Prostheses Earl E. 
Vanderwerker, Jr., M.D. JACPOC 1976 Vol 15, Num 5" . 
4.  KENYA STANDARD                                  DKS 2612 -2: 2:2017 
© KEBS 201 7 LOWER LIMB PROSTHESIS.  6 5. "A Brief History of Prosthetics" . inMotion: A Brief History of Prosthetics . 
November –December 2007. Retrieved 23 November 2010.  
6. Long, Ivan A. (1985). "Normal Shape -Normal Alignment (NSNA) Above -Knee 
Prosthesis" . Clin Prosthet Orthot  9 (4): 9 –14. 
 
7. "How artificial limb is made  – Background, Raw materials, The manufacturing 
process of artificial limb, Physical therapy,  Quality control" . Madehow.com. 1988 -
04-04. Retrieved 2010 -10-03. 
 
8. Ephraim, P.L. and Dillingham, T.R. and Sector, M. and Pezzin L.E. and 
MacKenzie, E.J. (2003) Epidemiology of Limb Loss and Congenital Limb 
Deficiency: A Review of the Literature.  
9. Mak, A. F.T. and Zhang, M. and Boone, D.A. (2001) State -of-the-art research in 
lower -limb prosthetic biomechanicssocket interface: A review.  
10. Jian, Y. and Winter, D.A. and Ishac, M.G. and Gilchrist, L. (1993) Trajectory of 
the body COG and COP during initiation and  termination of gait.  
11. ANDRYSEK, J., "Lower -limb prosthetic technologies in the developing world: A 
review of literature from 1994 –2010" Prosthetics and Orthotics International, 
2010; Early Online, 1 –21. 
12. Martin, Craig W. (November 2003) “Otto Bock C -leg: A review of its 
effectiveness”. WCB Evidence Based Group  
13. Sherman, E. David (1964). "A Russian Bioelectric -Controlled Prosthesis: Report 
of a Research Team from the Rehabilitation Institute of M ontreal" . Canadian 
Medical Association Journal  91 (24): 1268 –1270. PMC  1927453 . 
PMID  14226106 . 
14. "Touch Bionics" . Touch Bionics. Retrieved 2010 -10-03. 
 
15. "Cost of Prosthetics Stirs Debate" , Boston Globe , 5 July 2005. Retrieved  11 
February 2007.  
16. "ICRC: Trans -Femoral Prosthesis  – Manufacturing Guidelines"  (PDF). Retrieved 
2010 -10-03. KENYA STANDARD                                  DKS 2612 -2: 2:2017 
© KEBS 201 7 LOWER LIMB PROSTHESIS.  7 17. ANDRYSEK, J., "Lower -limb prosthetic technologies i n the developing world: A 
review of literature from 1994 –2010" Prosthetics and Orthotics International, 
2010; Early Online, 1 –21. 
18. Krebs, D.E. and Edelstein, J.E. and Thornby, M.A. (1991) Prosthetic 
Management of Children with Limb Deficiencies.  
19. Murdoch, Ge orge; A. Bennett Wilson, Jr. (1997). A Primer on Amputations and 
Artificial Limbs . United States of America: Charles C Thomas Publisher, Ltd. 
pp. 3–31. ISBN  0-398-06801 -1.   
20.  ‘Biomechanics of running: from faulty movement patterns come injury.' Sports 
Injury Bulletin.  
21. Edelstein, J. E. Prosthetic feet. State of the Art. Physical Therapy 68(12) Dec 
1988: 1874 –1881.  
22. Transtibial Prosthesis. (2010). Centre for Prosthetics and Orthotics. Retrieved 
November 12th, 2012 from http://cpo.biz/transtibial -prosthesis/  . 
23. Vander Waarde T, Michael J. Prosthetic management. In: American Academy of 
Orthopaedic Surgeons. Atlas of Limb Prosthetics: Surgical, Prosthetic, and 
Rehabilitation Principles, 2nd ed. St. Louis: Mosby -Year Book; 1992:539 -552. 
24. Northwestern University Prosthetic Orthotic Center. Hip Disarticulation Fitting 
Manual. Chicago: Northwestern University; 1991.  
 
3 Terminology  
For the purpose of this standard, the following ter ms and definitions  given in ISO 9999 
shall apply:  
4. Different levels of lower limb prostheses  
4.1 Lower limb Prosthesis   
Device shall replace  a missing leg and is made up of components  fabricated by a 
manufacturer . 
The two main subcategories of lower ex tremity prosthetic devices are;  
 1. Trans-tibial (any amputation transecting the tibia bone or a congenital anomaly 
resulting in a tibial deficiency).  
2. Trans-femoral (any amputation transecting the femur bone or a congenital 
anomaly resulting in a femora l deficiency). In the prosthetic industry a trans -tibial KENYA STANDARD                                  DKS 2612 -2: 2:2017 
© KEBS 201 7 LOWER LIMB PROSTHESIS.  8 prosthetic leg is often referred to as a "BK" or below the knee prosthesis while the trans -
femoral prosthetic leg is often referred to as an "AK" or above the knee prosthesis.  
 
 
4.2 Level of Amputati on. 
 
1. Partial foot Amputation.  
2. Syme’s  Amputation.  
3. Transtibial  Amputation.  
4. Transfemoral  Amputation .  
5. Knee Amputation .  
6. Hip disarticulation  
7. Hemipelvectomy  
 
 KENYA STANDARD                                  DKS 2612 -2: 2:2017 
© KEBS 201 7 LOWER LIMB PROSTHESIS.  9 3.3.1 Partial foot prostheses.  
The purpose is to restore foot function particularly in walking to si mulate the shape of 
the missing foot segment .  
Indication  
1. Loss of one or more toes.  
2. Transmetatarsal amputation.  
3. Amputation or disarticulation through tarsals.  
 
 
  
 
 
 
 3.3.2 Syme’s Amputation.  
Closed expandable syme’s prosthesis more patella tendon bearing  (PTB) and less end 
bearing.  
 
 
 
3.3.3 Trans -tibial prostheses.  
Amputation of the lower limb between knee joint and ankle joint.  KENYA STANDARD                                  DKS 2612 -2: 2:2017 
© KEBS 201 7 LOWER LIMB PROSTHESIS.  10 Various types and models of transtibial prostheses exist, and the final product will be 
determined through consultation with th e prosthetist and upon consideration of many 
factors including the patient's functional ability, stump size and shape, and funding 
source.  
 
 
 
  
 
3.3.4 Trans -femoral  
Trans -femoral (above knee) prosthetics refers to an artificial limb replacement where 
the knee joint has been removed and the individual still has part of the femur or 
thighbone intact.  
Our goal in prosthetics is to fit the client comfortably with the greatest return of function, 
and to make it look as natural as possible. To achieve this goal , we must create an 
appropriate style socket (the part the residual limb fits into), and provide the best design 
knee, ankle, and foot to fit the client’s life style requirements.  
 
 
 
 
KENYA STANDARD                                  DKS 2612 -2: 2:2017 
© KEBS 201 7 LOWER LIMB PROSTHESIS.  11 
 
 
 
 
 
 
 
 
 
 
 
3.3.5 Knee Disartic ulation ( Through knee amputation).  
Knee disarticulation is when the knee joint is cut, severing the lower leg. The thigh is 
retained entirely.  
A prosthetic foot, knee joint, adapters and connecting elements to the prosthetic socket 
form the artificial limb for this level. The socket is the c omponent that connects the 
artificial limb to the residual limb.  
What is known as a cosmetic cover can be applied over the prosthesis to make it 
cosmetically appealing.  KENYA STANDARD                                  DKS 2612 -2: 2:2017 
© KEBS 201 7 LOWER LIMB PROSTHESIS.  12 
 
 
 
3.3.6 Hip Disarticulation (Through Hip) amputation . 
In hip disarticulation, the am putation is performed in the area of the hip joint. With this 
type of amputation, the pelvis subsequently has to control the prosthesis.  
A prosthetic foot, knee joint, hip joint, adapters and connecting elements to the 
prosthetic socket are needed for the  fitting of the artificial limb. The socket is the 
component that connects the artificial limb to the residual limb.  
What is known as a cosmetic cover can be applied over the prosthesis to  make it 
cosmetically appealing.  
 
  
 KENYA STANDARD                                  DKS 2612 -2: 2:2017 
© KEBS 201 7 LOWER LIMB PROSTHESIS.  13 
3.3.7 Hemipelvectomy  
 Hemipel vectomy , the entire leg and parts of the pelvis up to the sacrum are amputated. 
With this type of amputation, the pelvis subsequently has to control the artificial limb.  
A prosthetic foot, knee joint, hip joint, adapters and connecting elements to the 
prosthetic socket are needed for the fitting of the artificial limb. The socket is the 
component that connects the artificial limb to the residual limb.  
What is known as a cosmetic cover can be applied over the prosthesis to make it 
visually inconspicuous.  KENYA STANDARD                                  DKS 2612 -2: 2:2017 
© KEBS 201 7 LOWER LIMB PROSTHESIS.  14 
 
 
 KENYA STANDARD                                  DKS 2612 -2: 2:2017 
© KEBS 201 7 LOWER LIMB PROSTHESIS.  15  
4.  Devices  / accessories  used after amputation of both lower limbs and the 
pelvis  
4.1 Socket  
This important part serves as an interface between the residuum (stump ) and the 
prosthesis, allowing comfortable weight -bearing, movement control and propriocep tion. 
Its fitting is one of the most challenging aspects of the entire prosthesis. The difficulties 
accompanied with the socket are that it needs to have a perfect fit, with total surface 
bearing to prevent painful pressure spots. It needs to be flexible, but sturdy, to allow 
normal gait movement but not bend under pressure.  
 
4.2 Shank & Connectors  
This part creates distance and support between the knee -joint and the foot (in case of 
upper -leg prosthesis) or between the socket and the foot. The type of conn ectors that 
are used between the shank and the knee/foot determines whether the prosthesis is 
modular or not. Modular means that the angle and the displacement of the foot in 
respect to the socket can be changed after fitting.  
4.3 Foot  
Providing contact t o the ground, the foot provides shock absorption and stability during 
stance. Additionally it influences gait biomechanics by its shape and stiffness. There are 
different types of feet, with greatly varying results concerning durability and 
biomechanics. . These results are for adults and will probably be worse for children due 
to higher activity levels and scale effects.. The heel is compressed during initial ground 
contact, storing energy which is then returned during the latter phase of ground contact 
to help propel the body forward.  
 
 
 
 KENYA STANDARD                                  DKS 2612 -2: 2:2017 
© KEBS 201 7 LOWER LIMB PROSTHESIS.  16 4.4  Knee -joint  
In case of a trans -femoral amputation there also is a need for a complex connector 
providing articulation, allowing flexion during swing -phase but not during stance.  
 
 
 
 
 
6.Design consideration  
There are m ultiple factors to consider when designing a transtibial prosthesis. 
Manufacturers must make choices about their priorities regarding these factors.  
 
 
Other  
The buyer is also concerned with numerous other factors:  
 Cosmetics  
 Cost 
 Ease of use  
 Size availabili ty 
 
7.Cost  
High -cost 
. The cost of an artificial limb does recur because artificial limbs are usually replaced 
every 3 –4 years due to wear and tear . In addition, if the socket has fit issues, the socket 
must be replaced within several months. If height is an issue components can be 
changed, such as the pylons.  
 
Low-cost]  
Low cost above knee prostheses often provide only basic structural support with limited 
function. This function is often achieved with crude, non -articulating, unstable, or 
manually locking knee joints.  
8.MATERIALS  
An important consideration in the design and fabrication of a limb prosthesis is the type 
of material used for its construction. Interface materials wil l influence the comfort of the 
socket. Structural materials will affect the strength and weight of the overall prosthesis. 
The prosthetist has a vast array of materials to choose from in designing the optimal 
prosthesis for a particular individual.  
. Each  individual needs to be evaluated with careful consideration given to their lifestyle, 
expectations and physical characteristics.  
 
Plastic Polymer Laminates (Thermosets)  KENYA STANDARD                                  DKS 2612 -2: 2:2017 
© KEBS 201 7 LOWER LIMB PROSTHESIS.  17 Plastic polymer laminates are widely used for the fabrication of prosthetic sockets.  This 
process is performed under vacuum pressure in order to create a product that is 
lightweight and strong.  
Common types of plastic polymer laminates used in prosthetics are acrylic, epoxy and 
polyester. The advantage of plastic laminates is that the pr osthetist has a great deal of 
control over the strength, stiffness and thickness of the finished product. These 
variables can be controlled such that the finished product may be strong and thick in 
certain areas and thin and relatively light in others.  
One significant disadvantage of these thermoset resins compared with sheet 
thermoplastics is that the laminate is difficult and limited in its ability to be remolded 
after original fabrication. This means that if a specific area of the socket is 
uncomfortabl e due to tightness after the prosthesis is in use, it will be more difficult for 
the prosthetist to heat and remold that area.  
  
Reinforcement textiles  
Reinforcement textiles are the fabrics used in a laminate to provide strength. These 
include fiberglass,  nylon, Dacron, carbon, and Kevlar.  
These materials all have their advantages and disadvantages. For example, carbon 
fiber is used to create thin, lightweight and strong prosthetic sockets. This is one reason 
why a prosthetist might use several reinforcem ent materials in combination, a 
composite, to design a prosthetic socket. Carbon fiber is also used in several of the 
dynamic response (energy storing) feet and to create strong lightweight pylons.  
 
Thermoplastics   
Sheet thermoplastics are widely used  fo r prosthetic interfaces as well as structural 
components. These materials are available in sheet form in various thickness and 
colors. The most basic types of sheet thermoplastics are polypropylene and 
polyethylene.  
In addition to PP and PE , there are a multitude of "blended" plastics available to the 
prosthetist. Characteristics of these materials vary from very stiff to very flexible. A good 
example of this is Co -Polymer, which is a blend of polypropylene and ethylene creating 
a material that is fairly rigid yet more flexible and crack resistant than straight 
polypropylene. Stiff materials are often used for support so that the forces associated 
with walking can be transmitted from the amputee to the floor. The most common test 
socket material today is C lear Co -Polyester thermoplastic.  
Silicone and similar materials   
Silicone is  used as a padding material in sockets, as a means of suspension in the 
silicone suction socket (3S Iceross type) and is the material of choice when making high 
quality cosmetic leg restorations, to name a few. This material comes in many forms KENYA STANDARD                                  DKS 2612 -2: 2:2017 
© KEBS 201 7 LOWER LIMB PROSTHESIS.  18 and can be made in a firm durometer or a very soft durometer. When made in a very 
soft durometer, silicone not only provides excellent padding but also protects the skin 
from friction (shea r). This can be very important because friction often is the cause of 
skin breakdowns. The silicone suction socket uses what could be called a silicone 
"sock" worn directly against the skin that incorporates an attachment pin at the bottom, 
locking the soc k, and the amputee, into the prosthesis.  
 
Metals   
Th metal in a prosthetic components include  knees, pylons, ankles and rotators . These 
components can be made of aluminum, stainless steel and titanium.  
Aluminum, in general, is considered as a lightweigh t alternative to steel. It's not as 
strong but depending on the particular application it is often strong enough to meet the 
design criteria and pass the necessary testing procedures. Certain knees are fabricated 
of aluminum, taking advantage of its light weight. Some of these knees are very strong 
and durable owing much of their strength to the geometry of the knee as well as the 
material used.  
Steel is certainly strong but it is relatively heavy. Because steel is strong, it can be used 
to create small co mponents that may rely more on the strength of the material than the 
geometry of the design. Small knee units used for endoskeletal prostheses were 
originally made of steel. The material is fairly heavy however very little material is 
needed to construct t hese knees.  
Titanium is a strong, lightweight alternative. The penalty for using titanium is higher 
cost. Many of the endoskeletal components originally designed of steel are now 
available in titanium.   
 
Liners and Sleeves   
Liners are the materials that are either made during the fabrication process to fit inside 
the socket or those materials added after the leg is in use in order to accommodate for 
shrinkage of the residuum. Pelite is probably the most commonly used "soft socket" 
liner material. It is a closed -cell polyethylene foam material that is available in various 
durometers. This material is thermoformable, meaning that it can be heated and formed 
over the plaster cast. Pelite and materials like it have the advantage that they are easily 
adjusted b y adding additional material when the residual limb shrinks. It is also 
convenient to use these materials if suspension of a below -knee prosthesis  
Sleeves are worn over the outside of the prosthesis and are used to provide 
suspension. Some common material s used for sleeves are: neoprene, silicone, latex, 
and urethane. Sleeves are worn over the prosthesis and extend onto the thigh of the 
below -knee amputee. The most common materials used in prosthetics today are 
various plastics, but the more traditional ma terials such as wood, leather, metal, and 
cloth still have a role to play  KENYA STANDARD                                  DKS 2612 -2: 2:2017 
© KEBS 201 7 LOWER LIMB PROSTHESIS.  19  
 
Wood  
Wood is often used in lower -limb prostheses to provide shape and interior structural 
strength. The inherent properties of wood make it a very difficult material to replace: it  is 
lightweight, strong, inexpensive, easy to work, and consistent in texture. Basswood 
(linden), willow, and poplar wood are most commonly used for prosthetic knees and 
shins because they are lightweight, strong, and free from knots and can be shaped 
easily by using standard woodworking tools. When a prosthesis is finished, it is 
hollowed out until the wood is only 6 mm (1/4 in.) thick to reduce weight.  
Hardwoods are also used in lower -limb prosthetics. Solid -ankle, cushion -heel (SACH) 
feet have an interio r hardwood keel that provides structural strength to the foot.  
Leather  
Leather is another material still commonly used in prosthetics for suspension straps, 
waist belts, and socket linings. Leather is easy to work with, has a soft natural feel, and 
is bio compatible.  
 
Cloth  
Cloth is used for prosthetic socks, waist belts, straps, and harnesses for upper -limb 
prostheses. Probably the greatest use of cloth is for prosthetic socks, which can be 
considered analogous to athletic socks since they keep the skin d ry, cushion the limb, 
absorb shear forces, and take up volume to improve the fit. Prosthetic socks are 
commonly made of wool, cotton, or blends of these natural fibers often combined with 
nylon, Orion, acrylics, or other man -made materials.  
Wool is the mos t common material used for prosthetic socks because of its 
characteristic elasticity, cushioning, and ability to absorb moisture without feeling damp. 
Wool also has good resistance to acids from perspiration. The blend of domestic and 
foreign wool fleece u sed in prosthetic socks provides greater resistance to shrinkage. 
Pure wool, however, must be washed carefully in a mild soap that will dissolve in 
lukewarm water. The sock should be rinsed in lukewarm water as well since a change in 
temperature will affec t it adversely. Wool prosthetic socks should be dried carefully by 
first removing the excess water, wrapping them in a towel, and then drying them away 
from sunlight or any other direct heat. The recent development of machine -washable 
wool should reduce th e need for hand washing in the future.  
Cotton is also used for prosthetic socks but is more common in the form of a stockinette 
used to protect the limb during casting procedures. Cotton is also blended with wool in 
prosthetic socks, and some 100% cotton p rosthetic socks are available.  
Plastics  
Nylon is used for prosthetic sheaths, plastic laminations, bushings, suction valves, and 
nylon stockings to cover prostheses. The major advantages of this man -made fiber are KENYA STANDARD                                  DKS 2612 -2: 2:2017 
© KEBS 201 7 LOWER LIMB PROSTHESIS.  20 its strength, elasticity, and low coeffic ient of friction. Nylon prosthetic sheaths are in 
common use for transtibial amputees. A thin sheath worn directly over the skin 
significantly reduces shear stresses and helps to pull moisture away from the skin into 
the outside prosthetic socks. A nylon s tockinette provides inherent strength to nearly all 
prosthetic laminations.  
Acrylics are thermoplastics that have greater durability and strength than polyester 
resins do. Acrylic fibers are frequently used in the newer synthetic blends for prosthetic 
socks since this material is soft, durable, and machine washable. Acrylic resin is 
increasingly popular for laminations in prosthetics because its high strength permits a 
thinner, lighter -weight lamination and its thermoplastic properties allow easier 
adjustm ents of the prosthesis by reheating the plastic and remolding it locally. Acrylic 
resins tend to have a softer feel than polyester resins but are more difficult to use during 
fabrication. Clear acrylics have been used for years in the sign and building ind ustry for 
skylights and enclosures for shopping centers; they do not yellow and have good 
weather resistance.  
Polyester resin is a thermosetting plastic that is most commonly used for laminations in 
prosthetics. Thermosetting plastics cannot be heated and reformed after molding 
without destroying their physical properties. Polyester resins come in a liquid form that 
can be pigmented to match the patient's natural skin tone  
9.Cosmesis  
Cosmetic prosthesis has long been used to disguise injuries and disfigurem ents. With 
advances in modern technology, cosmesis , the creation of lifelike limbs made from 
silicone  or PVC has been made possible. Such prosthetics, such as artificial limbs , can 
now be made to mimic the appearance actual ones . Custom -made cosmeses are 
generally more expensive, while standard cosmeses come ready -made in various sizes, 
although they are often not as realistic as their custom -made counterparts. Another 
option is the custom -made silicone cover, which can be made to match a person's skin 
tone but not details such as freckles or wrinkles.