Khan Mohammad Junayed, Stoupine Anna, Farha Kamal, Kim Ji Hee, Klinoubol Poovasit
Montefiore Mount Vernon Hospital, Mount Vernon, New York.
St. John's Episcopal Hospital, Far Rockaway , New York.
Wound Manag Prev. 2021 Mar;67(3):12-20.
Although offloading foot ulcers with a total contact cast (TCC) remains the cornerstone of managing these wounds, the TCC is underutilized. Patient intolerance and potential iatrogenic complications due to TCCs' general lack of customizability and the inability to address flexible biomechanical deformities that are not in the sagittal plane may be one of the reasons patients with foot ulcers do not receive this crucial component of care.
To describe the use of a novel approach to the standard TCC technique that uses strategic padding to potentially increase patient compliance and comfort while decreasing the likelihood of iatrogenic ulceration, as well as to correct flexible frontal plane biomechanical deformities with casting tape that is pulled medial to lateral, or lateral to medial, to bring the plantar surface of the foot to neutral position.
The custom total contact cast (C-TCC) was used in a 54-year-old woman who had diabetes, obesity, and a flexible cavovarus foot type with a recurring plantar fifth metatarsal base wound. Weekly debridement followed by silver dressings and C-TCC application were performed. The latter included strategic padding, 2 forms of plaster of paris with contouring, fiberglass, and medial-to-lateral positioning of the foot during application.
This case study describes two (2) treatment episodes, with a focus on the second episode. At initial presentation, the ulcer took 5 weeks to heal. During the second treatment, a 48.7% reduction in wound volume was noted after 1 week. By the fourth week of treatment, a 98.7% wound volume reduction was achieved. By the ninth week, the ulcer epithelialized completely. At 1-month and 12-month follow-ups, the site remained fully epithelialized. No iatrogenic ulcerations, cast discomfort, or ambulatory dysfunction were reported by the patient.
In this case, the C-TCC helped address flexible frontal plane deformities and facilitated healing. Randomized, controlled clinical studies to evaluate the safety and effectiveness of different TCC methods are needed to guide care and improve the utilization of optimal offloading methods for the management of plantar foot ulcers.
尽管使用全接触石膏（TCC）减轻足部溃疡压力仍是处理这些伤口的基石，但TCC的使用未得到充分利用。患者耐受性差以及由于TCC普遍缺乏定制性以及无法解决非矢状面的灵活生物力学畸形而导致的潜在医源性并发症，可能是足部溃疡患者未接受这一关键治疗环节的原因之一。
描述一种对标准TCC技术的新颖方法，该方法使用策略性衬垫来潜在地提高患者的依从性和舒适度，同时降低医源性溃疡的可能性，以及使用从内侧到外侧或从外侧到内侧牵拉的铸型带纠正灵活的额面生物力学畸形，以使足底表面恢复到中立位置。
定制全接触石膏（C-TCC）应用于一名54岁患有糖尿病、肥胖症且具有灵活高弓内翻足类型且第五跖骨基底反复出现足底伤口的女性。每周进行清创，随后使用银敷料并应用C-TCC。后者包括策略性衬垫、两种塑形的巴黎石膏、玻璃纤维以及在应用过程中足部从内侧到外侧的定位。
本病例研究描述了两个治疗阶段，重点是第二个阶段。初次就诊时，溃疡需要5周愈合。在第二次治疗期间，1周后伤口体积减少了48.7%。到治疗第四周时，伤口体积减少了98.7%。到第九周时，溃疡完全上皮化。在1个月和12个月的随访中，该部位仍完全上皮化。患者未报告医源性溃疡、石膏不适或行走功能障碍。
在本病例中，C-TCC有助于解决灵活的额面畸形并促进愈合。需要进行随机对照临床研究以评估不同TCC方法的安全性和有效性，以指导治疗并提高用于治疗足底溃疡的最佳减压方法的利用率。
