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Total-Contact Casting as an Adjunct to Promote Healing of Pressure Ulcers in Amputees

Department of Surgery, New York University School of Medicine, New York, NY

Bart E. Muhs, MD

Thomas Maldonado, MD

Division of Vascular Surgery, New York University School of Medicine, New York, NY

Eyal Ben-Arie, MD

Department of Surgery, New York, NY

Peter Sheehan, MD

Diabetic Foot and Wound Center, Hospital for Joint Disease, New York, NY

Paul J. Gagne, MD

New York University School of Medicine, Department of Surgery, Division of Vascular Surgery, 530 First Ave., Suite 6F, New York, NY 10016 paul.gagne{at}med.nyu.edu

Partial foot amputations have become increasingly prevalent among long-lived diabetic patients. These patients have lower extremity neuropathy and are prone to ulceration at their amputation site. These ulcers are difficult to heal, and they place a significant financial and resource burden on the healthcare system. We examined the efficacy of total-contact casts (TCC) in diabetic amputees with nonhealing partial foot amputation site neuropathic ulcers. Data were collected retrospectively on all patients with amputations who were treated with a total-contact cast between December 2000 and December 2003. Seventeen patients (13 men, 4 women) with amputation site ulceration were identified. All patients were diagnosed with neuropathy secondary to diabetes and none had wound healing compromised by ischemia. The initial ulcer averaged 1,169 mm² with a depth of 2.77 mm. Patients were treated with an average of 7.9 cast applications over 8.4 weeks; 47% (8/17) of ulcers healed, but 29% (5/17) of patients were unable to complete their recommended treatment course secondary to complications from the TCC. Of the patients who were able to complete their treatment course, the healing rate was 66.7% (8/12). The recurrence rate for healed ulcers was 63% (5/8). Partial foot amputations with neuropathic ulcers present a very difficult problem to the vascular surgeon. Patient compliance and underlying medical comorbidities limit the success rate. In patients who can complete a TCC treatment course, good short term results can be expected. However, recurrence rates are high following discontinuation of mechanical TCC off-loading.

Vascular and Endovascular Surgery, Vol. 40, No. 2, 135-140 (2006)
DOI: 10.1177/153857440604000208


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