Arnold Jonathan F, Marmolejo Valerie
1 Great River Wound and Hyperbaric Medicine Clinic, Great River Medical Center, West Burlington, IA, USA.
2 Scriptum Medica, University Place, WA, USA.
Foot Ankle Int. 2017 Oct;38(10):1126-1131. doi: 10.1177/1071100717716486. Epub 2017 Aug 11.
The total contact cast (TCC) is considered the gold standard for offloading of plantar diabetic foot ulcerations, yet its use remains suboptimal for a variety of reasons. Prefabricated TCC systems have been developed to help enhance TCC use. The primary objective of this study was to determine if healing rates obtained with use of a prefabricated roll-on TCC were similar to those reported with conventional TCC use. Secondary outcomes measured were the incidence of iatrogenic ulceration, amputation, and recurrent ulceration, and patient tolerance of the device.
A retrospective chart review was performed on all patients in whom TCC was used for treatment of an ulceration at our institution from April 2013 to December 2016. Seventy patients (132 ulcerations) were identified.
An 85.6% healing rate was achieved. Five subjects (7.1%) sustained 11 iatrogenic ulcerations. All resolved with local treatment and continued casting. Thirteen subjects (18.6%) underwent amputation. No amputation occurred because of TCC application technique or use. Fifteen ulcerations (12 subjects, 17.1%) recurred. Greater than 70% resolved with re-initiation of TCC use. Forty-three subjects (61.4%) tolerated use of the prefabricated roll-on TCC.
Similar healing rates and reduced rates of iatrogenic ulceration, amputation, and recurrent ulceration were attained with use of a prefabricated roll-on TCC. These results, good patient tolerance, and the reduced administrative and clinical time related to supply acquisition, training, and proper application supports use of this device as a viable alternative to a conventional TCC for treatment of plantar neuropathic foot ulcerations.
Level IV, case series.
全接触石膏（TCC）被认为是减轻足底糖尿病足溃疡压力的金标准，但由于多种原因，其应用仍未达到最佳效果。预制TCC系统已被开发出来以帮助提高TCC的使用。本研究的主要目的是确定使用预制滚涂式TCC的愈合率是否与传统TCC使用时报告的愈合率相似。次要测量结果包括医源性溃疡、截肢和复发性溃疡的发生率，以及患者对该装置的耐受性。
对2013年4月至2016年12月在我院使用TCC治疗溃疡的所有患者进行回顾性病历审查。共确定了70例患者（132处溃疡）。
愈合率达到85.6%。5名受试者（7.1%）出现11处医源性溃疡。所有溃疡经局部治疗和继续使用石膏后均愈合。13名受试者（18.6%）接受了截肢手术。没有因TCC应用技术或使用而导致截肢。15处溃疡（12名受试者，17.1%）复发。超过70%的复发溃疡通过重新使用TCC而愈合。43名受试者（61.4%）能够耐受预制滚涂式TCC的使用。
使用预制滚涂式TCC可获得相似的愈合率，并降低医源性溃疡、截肢和复发性溃疡的发生率。这些结果、良好的患者耐受性以及与供应获取、培训和正确应用相关的行政和临床时间的减少，支持将该装置作为治疗足底神经性足溃疡的传统TCC的可行替代方案。
IV级，病例系列。
