# Patent

## Title
Prosthetic socket liner

## Abstract

A removable liner used in conjunction with a socket for a prosthetic device, in which a vacuum is wicked across the entire area of a porous fabric of the liner, is disclosed. The liner preferably includes a shaped-layer made from one of either a silicone or a urethane and has an exterior surface, an interior surface and a passage therein which opens at each of the two surfaces and connects to a valve of the socket. The liner further includes a first porous fabric covering at least a portion of the exterior surface of the shaped-layer including the corresponding opening of the passage, and a second porous fabric covering at least a portion of the interior surface of the shaped-layer including the corresponding opening of the passage. A vacuum source coupled to the liner, via the valve on the socket, draws a vacuum which is wicked across the entire surface of the first and second porous fabrics which interface with the socket and the user's residual limb, respectively. The vacuum secures the socket to the liner and the liner to the residual limb of the user.

## Background
RELATED APPLICATIONS
This application is a continuation-in-part and claims the priority of U.S. application Ser. No. 12/586,235, titled “Prosthetic Socket” and filed on Sep. 18, 2009, now U.S. Pat. No. 8,282,686. The present application also incorporates by reference the disclosures of U.S. application Ser. Nos. 11/640,150, filed Dec. 14, 2006, Ser. No. 12/286,474, filed Sep. 30, 2008, and 61/192,386, filed Sep. 9, 2008.


TECHNICAL FIELD OF THE INVENTION
The present device relates to vacuum liner used in a socket assembly for a prosthetic device. In particular, the present device relates to a vacuum-mapped liner which resides within a socket assembly having an outer shell and an air barb communicating with the liner on the interior of the socket and for connection to an exterior vacuum source.
BACKGROUND OF THE INVENTION
The history of artificial limbs goes back to very remote times. In fact, there is some evidence that the Romans and the Greeks may have improvised some sort of substitute for limbs lost as a result of battles and the vicissitudes of life. Herodotus tells us of a prisoner who amputated his own foot in order to free himself from the shackle, after which he escaped and returned to his friends, who made a wooden foot.
The treasure trove that turned up at Capua in 1885 in a tufa tomb is probably the most valuable and indisputable evidence that artificial legs were made in early times. The relic is now on exhibition in the Museum of the Royal College of Surgeons, London. The official catalogue describes it thus: “Roman artificial leg; the artificial limb accurately represents the form of the leg. It is made with pieces of thin bronze, fastened by bronze nails to a wooden core. Two iron bars, having holes at their free ends, are attached to the upper extremity of the bronze. A quadrilateral piece of iron, found near the position of the foot, is thought to have given strength to it. There was no trace of the foot, and the wooden core had nearly crumbled away.”
From those early times to about the beginning of the 20th century, little or no advance was made in the art; and, as no evidence exists to prove to the contrary, it is quite reasonable to suppose that for many centuries the manufacture of artificial limbs was one of the lost arts.
In the early part of the 20th century, the Duke of Anglesea, being in need of an artificial leg, and possessing an inventive faculty, suggested to an English instrument maker what proved to be a very answerable substitute, a decided improvement on the primitive peg of the doughty Peter. The leg received but little improvement until the venturesome Selpho introduced it into this country with some admirable modifications of his own; here it met with American enterprise and began to thrive.
Typically, artificial limbs are held in place by a series of straps or some type of suspension system. Some are suspended with a silicone sleeve that has a pin that locks in place.
The earliest use of a vacuum to attach an artificial leg was with above the knee amputees using what is known as a suction socket. The “suction socket” uses the same principle as a suction cup where the maximum strength of the force holding the objects together is a function of the atmospheric pressure at the altitude of use. In artificial leg usage the suction or vacuum is reduced by the vapor pressure of the sweat at the internal temperature of the socket. Use of suction sockets on below knee amputees was not initially practical. The next advance in using vacuum was the introduction of the Harmony system which uses a mechanical pump operated by the energy of walking Each step operates a pump.
A vacuum system improves the fit and comfort between the device and the residual limb. A vacuum pump forces out air through a one-way valve, creating negative pressure with every step the patient takes. A tiny tube connects the pump to a weight-bearing socket which is enveloped in a urethane liner or sleeve. By improving suspension, the prosthesis offers better control and less pressure on the limb and liner. The pump is powered by the wearer's body weight. Taking a step compresses the device, which creates the vacuum between the liner and the socket.
Through the years, many socket structures have been developed for use with vacuum and non-vacuum systems alike. Many of these structures are represented in the patent literature. For example, U.S. Pat. No. 2,634,424 to O'Gorman discloses a double-walled socket of resiliently flexible material.
U.S. Pat. No. 5,007,937 to Fishman deals with a structure for enhanced retention of artificial limbs and method of fabrication in which an air impermeable sealing band of rubberized material is introduced between the patient's stump and the interior of a stump-receiving socket of an artificial limb, in one of two ways, depending on whether or not the patient wears a stump sock. If the patient wears a stump sock, the band of sealant material is impregnated into the stump sock. If the patient does not wear a stump sock, an impregnated sock is incorporated into the interior structure of the socket of the patient's prosthesis. The impregnated sock itself is fabricated by placing a conventional stump sock on a somewhat oversized form. An appropriate annular region on the sock is then masked off by means of tightly fitting plastic bags, and one of the plastic bags provides an enclosing outer sheath which encompasses the annular region and extends upwardly above the form. A rubberized material in liquid form is introduced through the top of the outer sheath and a vacuum is introduced below to draw the material into the annular region of the sock, so as top impregnate the same. The rubberized material penetrates the sock, is worked into an axially contoured shaped, and is then permitted to set. A stump-receiving socket for an artificial limb with an integral annular seal is fabricated by placing a stump sock with the seal on a cast of a patient's leg and then laminating the socket over the sock using conventional procedures for manufacturing stump-receiving sockets.
U.S. Pat. No. 5,108,456 to Coonan shows a prosthetic appliance for residual limb is disclosed comprising a prosthesis member having a cavity defined by side walls formed of a rigid molded material. A separate removable molded socket member formed of a flexible material is nested within cavity of the prosthesis member and is adapted to receive the residual limb. Several separate, independently inflatable bladders preferably attached to the exterior of the socket member, when inflated, act against the rigid side walls of the prosthesis member to resiliently force discrete portions of the socket member side walls inwardly to grip the residual limb. An inflation control means is provided in the form of at least one manually operable air pump and one or more manually operable air valves, one for each of said bladders, for selectively inflating the associated bladder separately and independently from the other bladders, so that the gripping pressure of the residual limb at each discrete portion of the socket member may be adjusted separately and independently by both the air pump and the air valves.
U.S. Pat. No. 5,156,629 to Shane is directed to a removable and adjustable prosthetic insert disposed between the stump of a limb and the socket of a prosthesis is comprised of a high strength, pliable polymeric material within which are formed a plurality of spaced air pockets, or voids, which are coupled together by a series of connecting channels, or passages. Using an air valve extending through the polymeric material and coupled to the closed air pocket/channel system, the air pockets may be inflated to fill the stump/socket inter-space and provide a tight-fitting, air cushioned prosthetic socket attachment. The air inflatable prosthetic insert can accommodate changes in the condition of the stump and applies a uniform prosthetic attaching force thereto. Other embodiments also employ an inflatable air cushion and make use of spaced, solid spheres disposed between air passages arranged in a grid-like array; and pinched tubing with interconnecting air passages to form a series of inflatable nodules. An air cushion isolates the limb stump from the hard, rigid prosthesis socket for user comfort and provides a custom fit for improved control and maneuverability of the prosthetic device.
U.S. Pat. No. 5,139,523 to Paton discusses an apparatus for mounting a socket above the knee of an amputee, wherein the socket is arranged for mounting a prosthesis to a lower terminal end thereof. The sleeve includes an internal cage formed of rigid rods, including hook members imbedded within a semi-spherical sleeve support, with the cage encased in a polymeric covering. A vent is provided through the sleeve support for venting interiorly of the socket. The socket may further include pneumatic chambers for enhanced comfort in support of the socket.
U.S. Pat. No. 5,888,231 to Sandvig describes a method of preparing a breathable, custom-molded liner for an artificial limb socket includes the steps of providing a liner comprising an open-celled foam material impregnated with a curable resin, activating the curable resin, and deforming the foam material by positioning a residual limb on one of opposing surfaces of the liner, and positioning the artificial limb socket on a second opposing surface of the liner until curing is substantially complete to create and retain an impression of the residual limb in the foam material. A liner blank useful for preparing an artificial limb socket, comprising a foam material impregnated with a curable resin and sewn into the shape of a sock for an artificial limb, is also described.
U.S. Pat. No. 6,585,774 to Dean involves a dynamic variable geometry prosthetic fitting system with fluid-filled bladders and automatically regulating their volumes to provide a continuously secure fit. This system can vary volume continuously to accommodate natural variation in an amputee's residuum. It makes reliable suction retention of a prosthesis easier for the prosthetist to achieve while reducing the potential for tissue lesions. By maintaining a continuous, secure fit, the amputee's sense of confidence and willingness to use the prosthesis increases.
U.S. Pat. No. 6,926,742 to Caspers is directed to a hypobarically-controlled artificial limb for amputees includes a single socket with a volume and shape to receive a substantial portion of the residual limb. A liner with a volume less than the residual limb is donned over the residual limb, with the liner tensioned into a total contact relationship with the residual limb. A sealed cavity is formed between the socket and the liner. A vacuum source is connected to the socket cavity thereby drawing the residual limb and liner into firm and total contact with the socket. To compensate for some air leakage past the seal, there is a mechanism to maintain the vacuum in the cavity. A plate/socket attachment connects the vacuum source to the cavity.
Among the disadvantages of known systems are size, weight, and difficulty of use. There are many amputees that cannot use known systems because of size (particularly smaller adults and children), age of the patient, and length of the stump. For many patients, the time-consuming steps and cumbersome strap systems involved in using known prostheses cause the patients to eschew prostheses entirely. Further, known sockets are subject to unhygienic conditions, as they collect perspiration from the residual limb, and bacteria and other contaminants from the ambient air surrounding the prosthesis.
It can thus be seen from the foregoing that the need exists for a prosthetic socket that ameliorates the drawbacks of known devices, while remaining easy-to-use, lightweight, and hygienic.
These together with other objects of the invention, along with the various features of novelty which characterize the invention are pointed out with particularity in the claims annexed to and forming a part of this disclosure. For a better understanding of the invention, its operating advantages and the specific objects attained by its uses, reference should be had to the accompanying drawings and descriptive matter in which there is illustrated embodiments of the invention.
SUMMARY OF THE INVENTION
Generally, a socket assembly for use with a prosthetic device for hygienically and comfortably securing a prosthetic to a residual limb for attachment to a vacuum source is disclosed and claimed. The socket assembly comprises an outer shell capable of receiving a residual limb, a skin interface secured to at least a portion of the interior of the outer shell, and an air barb for communication between the interior and the exterior of the socket. In an aspect of an embodiment, the air barb may be connected to a vacuum source for evenly distributing the force through the skin interface. An aspect of an embodiment of the present device includes that the skin interface is vacuum-permeable.
An additional embodiment of the present device is provided in which the socket assembly further comprises a high-vacuum valve for communicating between the interior and the exterior of the socket assembly. In an embodiment of the device, a diffusion pillow is provided between the intake of the air barb and the interior of the socket assembly, where the diffusion pillow may comprise a synthetic fiber pillow. An aspect of an embodiment of the socket assembly provides that the outer shell is fabricated from plastic, such as thermoformable plastic, or from PETG.
In another aspect of an embodiment, the skin interface may be fabricated from a textile material, including a three-ply textile material such as a synthetic textile material, or from wool. Yet another aspect of an embodiment of the disclosed socket assembly is that it further comprises an annular vacuum seal secured to the interior of the socket assembly, one aspect of the annular vacuum seal being that it may be formed from urethane or silicone. In an additional embodiment, the skin interface extends over substantially all of the interior of the socket and further comprises an annular band extending over a portion of the interior of the socket.
In still another embodiment, a removable liner may be used in conjunction with the socket. The liner is preferably comprised of a shaped-layer made from one of either a silicone or a urethane and having an exterior surface, an interior surface and a passage therein which opens at each of the two surfaces and connects to a valve of the socket. The liner further includes a first porous fabric covering at least a portion of the exterior surface of the shaped-layer including the corresponding opening of the passage, and a second porous fabric covering at least a portion of the interior surface of the shaped-layer including the corresponding opening of the passage. A vacuum source coupled to the liner, via the valve on the socket, draws a vacuum which is wicked across the entire surface of the first and second porous fabrics which interface with the socket and the user's residual limb, respectively. The vacuum secures the socket to the liner and the liner to the residual limb of the user.
These and other aspects of the invention may be understood more readily from the following description and the appended drawings.



BRIEF DESCRIPTION OF THE DRAWINGS
Embodiments of the invention are illustrated by way of example, and not by way of limitation, in the figures of the accompanying drawings and in which like reference numerals refer to similar elements and in which:
FIG. 1 is a perspective view of an embodiment of a socket assembly in accordance with the principles of the present invention;
FIG. 2 is a cross-sectional view taken generally along the plane parallel to line II-II of FIG. 1;
FIG. 3 is a side view of one embodiment of a liner made in accordance with the present invention;
FIG. 4 is a cross-section of the embodiment of FIG. 3;
FIG. 5 is a side view of one embodiment of a liner made in accordance with the present invention;
FIG. 6 is a cross-section of the embodiment of FIG. 5; and
FIG. 7 is a cross-section of an embodiment of the present invention illustrating “mapping” of an internal fabric.



DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS
In the following description, specific details are set forth in order to provide a thorough understanding of the invention. However, it will be apparent that the invention may be practiced without these specific details.
While this invention has been described in connection with the best mode presently contemplated by the inventor for carrying out his invention, the preferred embodiments described and shown are for purposes of illustration only, and are not to be construed as constituting any limitations of the invention. Modifications will be obvious to those skilled in the art, and all modifications that do not depart from the spirit of the invention are intended to be included within the scope of the appended claims. Those skilled in the art will appreciate that the conception upon which this disclosure is based, may readily be utilized as a basis for the designing of other structures, methods and systems for carrying out the several purposes of the present invention. It is important, therefore, that the claims be regarded as including such equivalent constructions insofar as they do not depart from the spirit and scope of the present invention.
The invention resides not in any one of these features per se, but rather in the particular combinations of some or all of them herein disclosed and claimed and it is distinguished from the prior art in these particular combinations of some or all of its structures for the functions specified.
FIGS. 1 and 2 illustrate a socket assembly 10 in accordance with the principles of the present invention. The socket assembly 10 is suitable for use with any vacuum-assisted prosthetic system, but finds particular utility with the systems claimed and described in U.S. Ser. No. 11/640,150 and U.S. Ser. No. 12/286,474, the specifications of which are incorporated by reference herein. The socket assembly 10 includes an outer shell 12 fabricated from an airtight and relatively rigid material. The outer shell material must be capable of being thermoformed or vacuum-formed over a plaster mold cast from a residual limb to conform to the residual limb of the amputee to which the prosthesis is fitted. It is contemplated that a variety of thermoplastic materials will perform well. Examples of such materials are polyethylene terephthalate, including PETG manufactured by Kodak and available from a variety of sources, and NorthPlex, available from Endolite, Inc. of Centerville, Ohio. The formed shell can be further reinforced using carbon fiber, Kevlar mat or other reinforcing materials and an appropriate adhesive system. The reinforcing material may be bonded to the socket using, e.g., a peroxide-cured thermoset acrylic polymer or the like.
A skin interface 14 is secured to the interior 16 of the outer shell 12, for example, by adhesive or integral molding. The skin interface 14 advantageously covers a majority of the contact area between the socket assembly 10 and the residual limb of the user. The skin interface 14 is fabricated from a vacuum-permeable material, such as a three-ply textile material. It is contemplated that materials such as wool used in the three-ply sock available from DAWFLO, or a three-ply synthetic material such as that used in the KNIT-RITE A-PLUS sock are suitable.
A high-vacuum valve 18 is connected between the interior 16 of the socket assembly 10 and the exterior 20 of the socket assembly 10. One example of a suitable valve is available from ESP HV Valve of Newton, N.J. The high-vacuum valve 18 must be capable of holding sufficient vacuum to secure the socket assembly 10 to the residual limb of the user. The amputee pulls tissue into the socket assembly 10 via the high-vacuum valve 18 in a conventional manner. Using a donning sleeve, the user pulls the residual limb tissue into the socket and HV valve, then removes the donning sleeve via the HV valve.
An air barb 22 is secured to the outer shell 12, and includes an intake communicating with the interior 16 of the socket assembly 10 and an outlet communicating with the exterior 20 of the socket assembly 10. The air barb 22 is adapted and constructed for connection to a vacuum system as described in U.S. Ser. No. 11/640,150. The barb 22 is the portal through which air is evacuated from the interior of the socket assembly 10. One example of a suitable air barb is available from Clippard Tools of Cincinnati, Ohio. A diffusion pillow 24 is positioned between the intake of the air barb 22 and the skin interface 14. The diffusion pillow 24, which can be fabricated from a nonwoven fabric, for example, a Dacron felt material such as is available from PEL Inc. of Cleveland, Ohio, or any other suitable synthetic textile material. The diffusion pillow 24 is used to diffuse the source of vacuum, which may generate 24′′HG, over a larger area to minimize the danger of tissue damage.
If desired, an additional vacuum seal 26 can be provided. The vacuum seal 26 is illustrated as an annular sealing member secured to the interior 16 of the socket assembly 10 at a location above the skin interface 14. The vacuum seal 26 is used as a supplemental vacuum seal for residual limbs with high volume fluctuations, and can be fabricated from a non-porous material such as urethane or silicone elastomer. One suitable seal member is an annular sleeve associated with suspension sleeves, as available from Otto Bock of Plymouth, Minn.
An alternative embodiment of a socket assembly 10 may provide for an annular band extending around a portion of the interior of the shell 16, as is known in the art. With many amputees, the end of the residual limb is unusually irregular in its topography. The irregular nature of such residual limbs renders it difficult to maintain vacuum in known socket assemblies. However, in the present invention, the vacuum is distributed through the skin interface. The annular band configuration of the skin interface 14 allows the contact area, and thus the vacuum distribution, to be limited to those areas of the residual limb having relatively regular and smooth surfaces, thus providing sufficient vacuum to retain the socket on the residual limb.
Selective placement of the skin interface allows the mapping of the socket to be placed only in those areas of the socket that will be in contact with portions of the residual limb capable of maintaining vacuum contact. Thus, areas with extensive scarring and/or irregular topography can be avoided, while areas with smoother tissue provide high-vacuum areas. For example, in a stance (standing) position, the contact portion of the residual limb is under high vacuum, while the irregular portion is under no vacuum. In a step (swing) action, the irregular portions of the residual limb will experience at most 2.5′′Hg to 3′′Hg, far less than will cause tissue damage.
The socket assembly 10 of the present invention provides many advantages over known systems. For example, it is contemplated that most applications of the socket assembly of the present invention will weigh on the order of 6 ounces to 2 pounds, and require 1 minute or less to put on. The present invention eliminates the need for the use of gels or lubricants to prepare the limb. Significantly, the direct contact of the skin interface with the limb allows the socket assembly of the present invention to vaporize perspiration, thus enhancing the comfort level and overall hygiene of the user. The reduced weight also simplifies the tasks required by systems that may be associated with the prosthetic device.
With reference to FIGS. 3-7, another embodiment of the present invention can be more readily explained. The prosthetic socket of all previous embodiments may be alternatively equipped with a detachable liner 30. Liner 30 is comprised of a shaped-layer 32 preferably manufactured from one of either a silicone or a urethane, as these materials provide the requisite flexibility needed. A passage 33, which may be positioned anywhere on the liner 30, passes through the shaped-layer 32 and opens at both an interior surface 34 and an exterior surface 36. The liner 30 is made complete by the addition of a first porous fabric layer 37 covering at least a portion of the exterior surface of the shaped-layer 32 and a second porous fabric layer 38 covering at least a portion of the interior of the shaped-layer 32. In both layers, 37 and 38, the fabric must cover the surface opening of the passage 33.
The fabric used for the first and second layers, 37 and 38, is preferably made of cotton, but may be a synthetic material (e.g., polyester) or a blended material (cotton/synthetic). Commercially available fabrics have been suitable for most applications.
Once the passage 33 is coupled to a vacuum source, the porous fabric layers, 37 and 38, perform the task of wicking the negative pressure about their entire surface area. As such, the area of the vacuum can be controlled by removing the fabric from specific areas to avoid vacuum pressure contact with damaged tissue or the like. For example, scarred areas of the residual limb may not have sufficient viable tissue or an area of the residual limb may otherwise be inadequate for application of a vacuum. Portions of the second porous fabric layer 38 corresponding to an injured area could be cut away, as illustrated in FIG. 7. Accordingly, vacuum pressure would not be wicked to the injured area. This is known as “mapping” the liner.
The embodiment illustrated in FIGS. 3 and 4 is best used with either a double-wall or single-wall socket, while the embodiment of FIGS. 5 and 6 is used with what is known as a brimless socket.
With respect to the above description, it is to be realized that the optimum dimensional relationships for the parts of the invention, including variations in size, materials, shape, form, function and manner of operation, assembly and use, and all equivalent relationships to those illustrated in the drawings and described in the specification, that would be deemed readily apparent and obvious to one skilled in the art, are intended to be encompassed by the present invention.
Therefore, the foregoing is considered as illustrative only of the principles of the invention. Further, since numerous modifications and changes will readily occur to those skilled in the art, it is not desired to limit the invention to the exact construction and operation shown and described, and accordingly, all suitable modifications and equivalents may be resorted to, falling within the scope of the invention.

## Claims

1. A liner for a socket of a prosthetic limb which is to be attached to a residual limb having at least one surface area unsuitable for application of vacuum pressure, the liner comprising:
a shaped-layer comprised of one of either a silicone or a urethane and having an exterior surface, an interior surface and a passage therein which opens at each of the two surfaces;
a first porous fabric covering at least a portion of the exterior surface of the shaped-layer including covering the corresponding opening of the passage; and
a second porous fabric which directly contacts the residual limb during use, the second porous fabric covering the interior surface of the shaped-layer including covering the corresponding opening of the passage wherein the second porous fabric includes at least one cut-out portion which corresponds to the at least one surface area of the residual limb unsuitable for application of vacuum pressure;
wherein, during use a negative pressure is maintained across the portion of the exterior surface covered by the first porous fabric and the interior surface covered by the second porous fabric excluding the cut-out portion when a vacuum source is coupled to the passage of the shaped-layer.

2. The liner of claim 1, wherein the first porous fabric and the second porous fabric are of the same material.

3. The liner of claim 2, wherein the material of the first and second porous fabric is cotton.

4. The liner of claim 2, wherein the material of the first and second porous fabric is polyester.

5. The liner of claim 2, wherein the material of the first and second porous fabric is a cotton/polyester blend.

6. The liner of claim 1, wherein the first porous fabric interfaces with a prosthetic socket during use.

7. A liner-socket combination for use with a prosthetic device which is to be attached to a residual limb having at least one surface area unsuitable for application of vacuum pressure, the combination comprising:
a socket formed to fit the residual limb of a user and having a prosthetic device attached thereto;
a vacuum source coupled to a valve seated in a sidewall of the socket; and
a liner detachably positioned within the socket and comprising:
a shaped-layer comprised of one of either a silicone or a urethane and having an exterior surface, an interior surface and a passage therein which opens at each of the two surfaces;
a first porous fabric covering at least a portion of the exterior surface of the shaped-layer including the corresponding opening of the passage; and
a second porous fabric which directly contacts the residual limb during use, the second porous fabric covering the interior surface of the shaped-layer including the corresponding opening of the passage wherein the second porous fabric includes at least one cut-out portion corresponding to the at least one surface area of the residual limb unsuitable for application of vacuum pressure;

wherein, during use a negative pressure is maintained across the portion of the exterior surface covered by the first porous fabric and the interior surface covered by the second porous fabric excluding the cut-out portion when the vacuum source is coupled to the passage of the shaped-layer via the valve.

8. The liner-socket combination of claim 7, wherein the first porous fabric interfaces with an interior surface of the socket.

9. The liner-socket combination of claim 8, wherein the first porous fabric is held to the interior surface of the socket during use by the creation of a negative pressure.

10. The liner-socket combination of claim 7, wherein the first porous fabric and the second porous fabric are of the same material.

11. The liner of claim 10, wherein the material of the first and second porous fabric is cotton.

12. The liner of claim 10, wherein the material of the first and second porous fabric is polyester.

13. The liner of claim 10, wherein the material of the first and second porous fabric is a cotton/polyester blend.

14. A method for securing a prosthetic device to a residual limb of a user, the residual limb having at least one surface area unsuitable for application of a vacuum, the method comprising the steps of:
forming a socket to fit properly to a desired residual limb, the socket having a cavity and a valve;
positioning a liner within the cavity of the socket, the liner comprising:
a shaped-layer comprised of one of either a silicone or a urethane and having an exterior surface, an interior surface and a passage therein which opens at each of the two surfaces and configured to connect to the valve of the socket;
a first porous fabric covering at least a portion of the exterior surface of the shaped-layer including the corresponding opening of the passage; and
a second porous fabric which directly contacts the residual limb during use, the second porous fabric covering the interior surface of the shaped-layer including covering the corresponding opening of the passage wherein the second porous fabric includes at least one cut-out portion which corresponds to the at least one surface area of the residual limb unsuitable for application of vacuum pressure;

connecting a vacuum source to the valve of the socket; and
drawing a vacuum to create a negative pressure across the portion of the exterior surface covered by the first porous fabric and the interior surface covered by the second porous fabric excluding the cut-out portion such that the liner is held to an interior surface of the socket and an exterior surface of a residual limb.