Thanks to Brad Poziembo, prosthetic resident, who shared the responses to his inquiry on the list serve as to problems people are having with elevated vacuum.

Here are the replies he received:

* Patient selection (Ex: cognitive ability)

* Socket tightness due to vacuum pressure

* Sealing Sleeve durability

* Not covered by all insurance companies

* Time consuming finding an air leak

* Tough to get adequate knee flexion

* Donning difficulty

* Not all amputees find reduced perspiration with system

* The amount of time required to get the right fit due tight tolerances

* Difficult to use with AKA and sealing off the proximal brim

* Maintenance

While all these are definately issues that pracitioners face, they can be adresses with careful fitting and adjustment and the results are worth the effort.

Thanks, Brad.