Ambulantes Zentrum für Diabetologie, Endoskopie und Wundheilung, Köln, Germany.
Department of Diabetology, Endocrinology and Woundhealing, Vinzenz Hospital Cologne, Köln, Germany.
J Diabetes Sci Technol. 2022 Jan;16(1):137-143. doi: 10.1177/1932296820964069. Epub 2020 Oct 23.
Irremovable total contact casts (TCCs) are the gold standard to offload diabetic foot ulcers (DFUs) and to immobilize feet with active Charcot neuro-osteoarthropathy (CN). They do not allow checks of the foot and are contraindicated in people with peripheral arterial disease (PAD). Frequently, removable TCCs and other removable devices are used because they allow wound care, modifications of the inner surface of the cast, and checks of the foot. The authors propose TCCs with ventral windows (VW-TCCs) whenever patients with high-risk conditions show poor adherence to wearing a removable cast all the time and access to the foot is necessary.
This retrospective study compares treatments with bivalved, removable TCCs applied prior to the introduction of the novel design (from 1 January 2016 to 1 July 2017, "") to treatments in the following period () with both bivalved removable TCCs and VW-TCCs in use.
Forty-five treatments after introduction (17 with the VW-TCC) showed a 52.8% lower median time to reach remission of the DFS than 41 controls (128/267 days, log-rank test = .013). Reasons given for not using the novel design were: sufficient offloading with a removable TCC (16), patient preference (six), anatomical conditions (two), casts applied as a service for other facilities (three), and calf ulcers (one). Adverse effects from both designs were uncommon and not severe.
VW-TCCs combine advantages of both removable and irremovable TCCs. Complications do not limit the use, even in patients with PAD.
不可拆卸的全接触石膏（TCC）是治疗糖尿病足溃疡（DFU）和固定活动性夏科氏关节病（CN）足部的金标准。它们不允许检查足部，并且在患有周围动脉疾病（PAD）的人中禁忌使用。由于它们允许伤口护理、对石膏内部表面的修改以及足部检查，因此经常使用可拆卸的 TCC 和其他可拆卸设备。只要高风险条件的患者对始终佩戴可拆卸石膏的依从性差，并且需要接触足部，作者就会提出带有腹侧窗的 TCC（VW-TCC）。
本回顾性研究比较了在引入新型设计之前（2016 年 1 月 1 日至 2017 年 7 月 1 日，“前”）应用分体式可拆卸 TCC 的治疗方法与随后时期（“后”）的治疗方法，当时同时使用分体式可拆卸 TCC 和 VW-TCC。
在引入后，45 种治疗方法（17 种使用 VW-TCC）达到 DFS 缓解的中位时间比 41 例对照（128/267 天，对数秩检验 =.013）降低了 52.8%。未使用新型设计的原因是：可拆卸 TCC 充分减压（16 例）、患者偏好（6 例）、解剖条件（2 例）、为其他机构提供服务而应用石膏（3 例）和小腿溃疡（1 例）。两种设计的不良反应均不常见且不严重。
VW-TCC 结合了可拆卸和不可拆卸 TCC 的优点。即使在 PAD 患者中，并发症也不会限制其使用。
