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

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.