CS14-038 Helping to Save Limbs--One Total Contact Cast at a Time

Donna Willemsen, RN BSN CWS, Cedar Park Regional Wound Care Center, Cedar Park, TX
Purpose: Illustrate use of Total Contact Casting* (TCC) to facilitate wound closure in patients with DFUs. Diabetes causes 56-83% of the estimated 125,000 lower extremity amputations performed annually1. Objective: Demonstrate healing of DFUs with TCC in  shorter time frame with higher percentage of healing than usual DF wound care without offloading component. Case 1--62 yo male with hx of DM, hepatitis, HTN, osteomyelitis with right TMA presented with right TMA wound of 2 years duration. Treatment included TCC, debridement and human fibroblast-derived dermal substitute with wound closure achieved in 15 weeks. Non-compliance resulted in re-opening of wound. With TCC and debridement; closure achieved in 11 weeks. Case 2—55 yo male with hx of DM, HTN, hyperlipidemia, amputation of left great toe presented with right plantar foot wound of 3 weeks duration. Treatment included TCC and debridement, closure achieved in 6 weeks. Case 3—52 yo male with hx of DM, HTN, hyperlipidemia,  I&D right plantar foot abscess presented with non-healing right foot ulcer of 4 weeks duration. Treatment included TCC, debridement and human fibroblast-derived dermal substitute; closure achieved in 7 weeks. Case 4—64 yo male with hx of DM, CHF, CAD, PVD, CVA, HTN, hyperlipidemia, I&D for abscess of left plantar foot wound with osteomyelitis presented  for HBO treatments. Wound treated with HBO, debridement and human fibroblast-derived dermal substitute, pt non-compliant with conventional off-loading, wound not responding. TCC added, closure achieved in 3 weeks. Results: All pts demonstrated improved healing with TCC. Conclusion: The most effective method of off-loading, which is also considered to be the gold standard, is the TCC2. Recent advances in wound dressings extend the utility of the total contact cast rather than replace it3.TCC resulted in healing of difficult DFU’s and is cost effective. Average length of treatment was 8 weeks.