As I am flying to the AAOP meeting in Chicago I am reading e-mailing comments on which technology would be appropriate or inappropriate to fit in Haiti. But what is appropriate here? Elevated vacuum has a multitude of advantages for those who have the necessary gadget tolerance to accept it and work with it every day. And if the person lives remotely, it will require more maintenance visits than simpler systems. It will cost more initially and in the long run.  Ethical fitting requires full disclosure of the hassles of elevated vacuum as well as the benefits. I have had 100% success in fitting elevated vacuum to transfemoral amputees.