Prevention of Bilateral Amputation with a Roll On Total Contact Cast System: What comes first, Amputation or Total Contact Casting?

Problem: Lower limb amputation, when performed to address chronic wounds, is associated with increased risk of wound recurrence, infection and mortality postoperatively.1 Therefore, when subsequent ulceration occurs in patients who have undergone prior amputation, it is vital that clinicians are able to close the wound rapidly. Off-loading to redistribute pressure is a basic principle that facilitates closure of ulcers of the foot, and yet many wound care providers avoid using this modality. Here, we present a case series of 4 diabetic ulceration patients, who were treated with a roll on total contact cast system (TEZ……), to  demonstrate how this system accelerates the closure of complex wounds at significant risk of below-knee amputation (BKA).
 

Materials and Methods: All wounds were debrided and dressed according to the protocol prescribed by the clinician. TEZ was subsequently applied, in the clinic, to each patient 1 week after surgery. After the initial TEZ application , patients returned each week to have the cast removed, the wound evaluated, debrided and re-dressed. A new cast was then applied.

Results: All wounds showed significant progress toward closure with TEZ treatment. At the time of this submission, 3 wounds, with an average initial wound area of 4.5 cm2 (range: 1– 10.8), have reached complete closure within an average  48 days (range: 28 – 60). The final wound, measuring 3.5 cm2, has reduced in size by 98% with only 3 applications of TEZ.

Conclusions: It is evident that the use of TCC has a direct effect on wound healing, to include a significant impact on total days required to heal. In this study, the simplicity and efficacy of the TEZ system provided wound care practitioners with an effective method of implementing the gold standard for off-loading diabetic foot ulcers and facilitating closure of wounds at significant risk of BKA.

Trademarked Items (if applicable): TEZ = TCC-EZ ® Total Contact Cast System, Integra LifeSciences Corp., Princeton, NJ

References (if applicable): 1. Quebedeaux TL, Lavery LA, Lavery DC. The development of foot deformities and ulcers after great toe amputation in diabetes. Diabetes Care. 1996 Feb 1;19(2):165-7.
2. Jupiter DC, Thorud JC, Buckley CJ, Shibuya N. The impact of foot ulceration and amputation on mortality in diabetic patients. I: from ulceration to death, a systematic review. International wound journal. 2016 Oct;13(5):892-903.
3. Buikema KE, Meyerle JH. Amputation stump: Privileged harbor for infections, tumors, and immune disorders. Clinics in dermatology. 2014 Sep 1;32(5):670-7.