Effectiveness of total-contact cast immobilization: Overview of randomized clinical studies conducted in foreign clinics and originaldata
https://doi.org/10.14341/2072-0351-5674
Abstract
Aim.
To evaluate effectiveness of unloading immobilization bandages manufactured from Soft Cast and Scotchcast materials.
Materials and methods.
The study included all patients (n=39) with diabetic foot ulcers treated with the use of total-contact cast technology (TCC)from 01.10.2007 to 01.03.2009. 31 patients presented with neuropathic foot ulcers and 8 with neuroischemic ulcers (in the absence of critical foot ischemia).26 and 13 were managed using non-removable and removable casts respectively. All were given standard local treatment of ulcers, supplementedby antibacterial therapy in 20 patients.
Results.
Treatment resulted in the healing of ulcers in 31 (79%) patients during 40.5?32.9 days (M?SD) (median 27, min 7, max 11 days). In 28(72%) of them, healing required 12 weeks to complete. TCC had to be removed in 8 (21%) patients because of low efficiency or complications. Newulcers or abrasions related to the use of TCC developed in 10 patients but treatment was discontinued only in one of them. We distinguished a subgroupof 12 patients comparable in terms of major characteristics (plantar stage 1A and 2A neuropathic ulcers according to Texas University classification)and unloading method (non-removable cast throughout the treatment period) with patients included in earlier randomized studies. In this subgroup,healing of 100% ulcers was completed within 12 weeks (median 22 (13-74) days).
Conclusion.
1. Efficiency of TCC in our practice is comparable with that in earlier publications. 2. The use of TCC is indicated not only for thetreatment of uninfected plantar neuropathic ulcers but also in some cases of neuroischemic and non-plantar ulcers. 3. Skin lesions from TCC is oflittle clinical significance and can be avoided by specialized education of the medical personnel involved in TCC manufacture.
To evaluate effectiveness of unloading immobilization bandages manufactured from Soft Cast and Scotchcast materials.
Materials and methods.
The study included all patients (n=39) with diabetic foot ulcers treated with the use of total-contact cast technology (TCC)from 01.10.2007 to 01.03.2009. 31 patients presented with neuropathic foot ulcers and 8 with neuroischemic ulcers (in the absence of critical foot ischemia).26 and 13 were managed using non-removable and removable casts respectively. All were given standard local treatment of ulcers, supplementedby antibacterial therapy in 20 patients.
Results.
Treatment resulted in the healing of ulcers in 31 (79%) patients during 40.5?32.9 days (M?SD) (median 27, min 7, max 11 days). In 28(72%) of them, healing required 12 weeks to complete. TCC had to be removed in 8 (21%) patients because of low efficiency or complications. Newulcers or abrasions related to the use of TCC developed in 10 patients but treatment was discontinued only in one of them. We distinguished a subgroupof 12 patients comparable in terms of major characteristics (plantar stage 1A and 2A neuropathic ulcers according to Texas University classification)and unloading method (non-removable cast throughout the treatment period) with patients included in earlier randomized studies. In this subgroup,healing of 100% ulcers was completed within 12 weeks (median 22 (13-74) days).
Conclusion.
1. Efficiency of TCC in our practice is comparable with that in earlier publications. 2. The use of TCC is indicated not only for thetreatment of uninfected plantar neuropathic ulcers but also in some cases of neuroischemic and non-plantar ulcers. 3. Skin lesions from TCC is oflittle clinical significance and can be avoided by specialized education of the medical personnel involved in TCC manufacture.
About the Authors
Oleg Viktorovich Udovichenko
Local Endocrinological Centre of South-Western administrative district, Polyclinic No 22, Moscow
Evgenia Viktorovna Bublik
I.M. Sechenov Moscow Medical Academy, Moscow
Nadezhda Viktorovna Maksimova
I.M. Sechenov Moscow Medical Academy, Moscow
Kira Yur'evna Pryakhina
Endocrinology Research Centre, Moscow
Olga Sergeevna Ermolaeva
Local Endocrinological Centre of South-Western administrative district, Polyclinic No 22, Moscow
Piter Spruit
Medical Laboratories, 3M Company, Noiss, Germany
Gagik Radikovich Galstyan
Endocrinology Research Centre, Moscow
References
1. International working group on the diabetic foot. The consensus report: Footwear and off-loading for the diabetic foot - an evidence based guideline. DVD edition, Amsterdam, 2007.
2. Mueller M., Diamond J., Sinacore D., et al. Total contact casting in treatment of diabetic plantar ulcers: controlled clinical trial // Diab. Care. - 1989. - 12. - Р. 384-388.
3. Caravaggi C., Faglia E., De Giglio R., Mantero M., Quarantiello A., et al. Effectiveness and safety of a nonremovable fiberglass off-bearing cast versus a therapeutic shoe in the treatment of neuropathic foot ulcers: a randomized study // Diab. Care. - 2000. - 23. - Р. 1746-1751.
4. Armstrong D.G., Nguyen H.C., Lavery L.A., van Schie C.H.M., Boulton A.J.M., et al. Off-loading the diabetic foot wound: a randomized clinical trial // Diab. Care. - 2001. - 24. - Р. 1019-1022.
5. Katz I.A., Harlan A., Miranda-Palma B., Prieto-Sanchez L., Armstrong D.G., et al. A randomized trial of two irremovable off-loading devices in the management of plantar neuropathic diabetic foot ulcers // Diab. Care. - 2005. - 28. - Р. 555-559.
6. Caravaggi C., Sganzaroli A., Fabbi M., Cavaiani P., Pogliaghi I., Ferraresi R., Capello F., Morabito A. Nonwindowed nonremovable fiberglass off-loading cast versus removable pneumatic cast (AircastXP Diabetic Walker) in the treatment of neuropathic noninfected plantar ulcers: a randomized prospective trial // Diab. Care. - 2007. - 30. - Р. 2577- 2578.
7. Piaggesi A., Macchiarini S., Rizzo L., Palumbo F., Tedeschi A., Nobili L.A., Leporati E., Scire V., Teobaldi I., Del Prato S. An off-the-shelf instant contact casting device for the management of diabetic foot ulcers: a randomized prospective trial versus traditional fiberglass cast // Diab. Care. - 2007. - 30. - Р. 586-590.
8. Van De Weg F.B., Van Der Windt D.A., Vahl A.C. Wound healing: total contact cast vs. custom-made temporary footwear for patients with diabetic foot ulceration // Prosthet. Orthot. In.t. - 2008. - 32(1). - Р. 3-11.
9. Petre M., Tokar P., Kostar D., Cavanagh P.R. Revisiting the total contact cast: maximizing off-loading by wound isolation // Diab. Care. - 2005. - 28. - Р. 929-930.
10. Kominsky S.J. The ambulatory total contact cast. //In: The High Risk Foot in Diabetes Mellitus. 1st ed. Frykberg RG, Ed. NY, Churchill Livingstone. 1991. - P. 449-455.
11. Armstrong D.G., Lavery L.A., Wu S., Boulton A.J.M. Evaluation of removable and irremovable cast walkers in the healing of diabetic foot wounds: a randomized controlled trial // Diab. Care. - 2005. - 28. - Р. 551-554.
12. Nabuurs-Franssen M.H., Sleegers R., Huijberts M.S.P., Wijnen W., Sanders A.P., Walenkamp G., Schaper N.C. Total contact casting of the diabetic foot in daily practice: a prospective follow-up study // Diab. Care. - 2005. - 28. - Р. 243-247.
13. Boogers J., Droogmans L. The BoDro-cast: the reusable total contact cast // In dit Verband. - 2000. - 10(1). - P. 21.
Review
For citations:
Udovichenko O.V., Bublik E.V., Maksimova N.V., Pryakhina K.Yu., Ermolaeva O.S., Spruit P., Galstyan G.R. Effectiveness of total-contact cast immobilization: Overview of randomized clinical studies conducted in foreign clinics and originaldata. Diabetes mellitus. 2010;13(2):50-55. (In Russ.) https://doi.org/10.14341/2072-0351-5674
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