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Every 30 seconds a lower limb is lost due to Diabetes Mellitus (DM) in the world (www.idf. org/home). 2 million (6.4%) Canadians have DM in 2010; the projection is 3.5 million (9.9%) in 2020. 15% patients with DM are at risk for foot ulcers (DFUs); 50% of non-traumatic amputations were related to DFUs; mortality rate of DFU amputations is 50% (Armstrong et al 2007; Statistic Canada, 2010).
Although Total Contact Cast (TCC)’s healing rate is 90%, various barriers results in only 2% Wound Clinics utilized TCC (Fife et al 2010; Greenagh 2012); lesser effective offloading devices are being used instead (Bus, 2012; Cavanagh & Bus, 2011; Wu et al 2008).
How did the author(s) solve it?
Traditional TCC requires extensive training. Manufacturers have simplified the casting process with fast-drying and easy-to-use kits that also reduce the risk for injury to the wound and surrounding skin. Manufacturer manuals, accredited skills development workshops, and webinars are available for Wound Care practitioners to acquire the skills to apply TCC (Fife et al 2010). Such kits enabled a Certified Wound Ostomy Continence Nurse (CWOCN) to utilize TCC for carefully selected patients in community setting.
What was discovered? With weekly TCC application, 6 patients with history of chronic planter DFUs for 9 months to 4 years had their DFUs closed in 3 to 7 weeks. Although some of the patients experienced dermal abrasion injuries, the results illustrated rapid DFU closure and positive patient experience. What can be learned from the experience?
Effective off-load is critical for healing DFUs. The use of TCC on these patients supported the potential use of TCC on selected patients by RNs specialized in wound care (CWOCNs) in community setting. Administrators and practitioners should consider utilizing TCC, the Gold Standard, for DFU treatment in clinical settings.