Limb Salvage 101: Utilizing an Easier Total Contact Casting along with Active Leptospermum Honey and Advanced Wound Care Modalities to Heal Chronic Wounds of the Foot in less than 33 Days

The aging population and prevalence of multiple comorbidities complicate the care of patients with chronic wounds of varying etiologies including diabetic foot ulcers.  Physicians and clinicians face the challenge of treating chronic wounds of the foot that frequently fail to move through the healing cascade in an orderly, timely fashion.  The medical world faces diabetic foot ulcers affecting 2.5 to 10.7% of all Diabetics which frequently result in amputations, which in turn has a dramatic effect on increased mortality rates. Offloading to redistribute pressure is a basic principle in healing chronic wounds of the foot including diabetic and neuropathic foot wounds.  There are various methods for offloading however, The Total Contact Cast (TCC) is considered the gold standard for offloading foot wounds.  This series of 5 patient cases with a total of 8 wounds provides significant evidence to further validate why TCC is and should continue to be gold standard for offloading.

     The patients had multiple comorbidities and wounds varying in time of existence from 1 and 1/2 months to 8 months.  Each patient’s wound were debrided and treated with various dressings including living skin substitutes, active leptorspermum honey, silver alginates, foams, hydrogels, antimicrobial packing, silver dressings, and  collagen, as well as hyperbaric oxygen.  All patients were offloaded utilizing a new easy form of TCC.  In evaluating the outcomes it is evident that using TCC has a direct effect on wound healing to include a significant reflection on total days to heal. These 5 patients had an average of 32.8 days to wound healing ranging from as few as 15 days to 47 days, this is significant especially with the variety of comorbidities, wound age, and over half of the patients were diabetic.  Further research is suggested with a larger variance of wound etiologies and more focused wound dressing applications to substantiate observations.