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

Introduction: Of the greater than 16 million people in the United States who have diabetes, 15% will develop at least one foot ulcer during the lifetime of their disease. Diabetes causes 56% to 83% of the estimated 125,000 lower extremity amputations performed annually (Thomas Hess BSN RN CWOCN, 2008).¹ Off-loading of the ulcer area is extremely important for the healing of plantar ulcers. Inadequate off-loading of the ulcer has been proven to be a significant reason for the delay of ulcer healing. The most effective method of off-loading, which is also considered to be the gold standard, is the total contact cast (TCC) (Alexiadou & Doupis, 2012).² No prefabricated device is likely ever to match its combination of protection completely from both normal and shear forces, and it approaches as near to a guarantee of patient compliance as any offloading technique can. Recent advances in wound dressings extend the utility of the total contact cast rather than replace it (Guyton MD, 2004).³

Aims: The aim of this poster is to illustrate the use of the TCC in a small series of patients with diabetic foot ulcers to facilitate closure. All patients have diabetes and other comorbidities which increase the challenge to successfully close their wounds.

Method: Total contact casting was used as offloading therapy in all patients in this case study. In some of the patients, the TCC was the only treatment provided, in others the TCC was used in conjunction with different treatments such as hyperbaric oxygen therapy and biological skin substitutes.

Outcome: This case series of diabetic foot ulcers demonstrates the effectiveness of how proper offloading using the TCC, alone or in conjunction with other treatments, can result in improved patient outcomes.