Wound closure results with Total Contact Cast (TCC) for Diabetic Foot Ulcers (DFUs) versus removable offloading devices: A Case Series

Aim According to the Canadian Diabetes Association, there are an estimated 3.5 million individuals with diabetes and DFUs affect an estimated 15 - 25%.1 Pressure is a factor in 90% of diabetic plantar ulcers.2 The Cochrane Collaboration concluded that non-removable, pressure-relieving casts are more effective in healing diabetes related plantar foot ulcers than removable casts, or dressings alone.3 Non-removable pressure-relieving casts involve enclosing the entire lower limb in a custom made cast which is often referred to as a total contact cast. The purpose of this case series was to evaluate the effectiveness of TCC for individuals who were previously treated with removable offloading devices yet experienced delays in wound healing. Method This case series includes six patients with plantar DFUs. In two cases, the wounds were limb threatening. In all instances, osteomyelitis was present and being appropriately treated by an infectious disease physician. These patients had TCC applied as per protocol until wound closure. Each cast change included, local wound bed preparation, reduction of callus, absorptive antimicrobial dressings, digital photography and wound measurements taken. A retrospective chart analysis was conducted to obtain previous wound healing history, treatment modalities and associated costs. The total cost (equipment and nursing hours) were calculated for both TCC and previous treatment and cost comparison to determine the effectiveness of TCC. Results Wound closure occurred within all patients over 5-8 weeks. The wounds healed in a shorter duration and nurse hours were reduced using TCC than previous treatments. Overall, equipment costs were reduced when using TCC versus their previous protocol of NPWT in 4/6 cases. Implications Improved wound healing rates and cost reduction of using TCC challenges wound care clinicians to consider incorporating the modality of TCC particularly as it pertains to limb salvage and cost efficiencies to the health care system.