The best of both worlds? Windowed casts for neuropathic and neuroischemic ulcers in #diabetes

Treatment of chronic plantar ulcer of the diabetic foot using an irremovable windowed fiberglass cast boot: prospective study of 177 patients – Ha Van – Diabetes/Metabolism Research and Reviews – Wiley Online Library.

This intriguing series of 177 patients from Georges Ha Van and coworkers seems to support previous works regarding irremovable offloading– even for those who have combined neuroischemic wounds or those that had removal of osteomyelitis. A 7% complication rate in this very high risk group is really promising.

While our team have been cautious about using windowed casts, this additional experience may continue to cause our opinion to evolve. What do you think?

 

Abstract

Objective

To evaluate the level of healing of chronic neuropathic plantar ulcers (NPU), using an irremovable windowed fiberglass cast boot (WCB) which is only opened after healing.

Method

A single center prospective study of a cohort of 177 diabetic patients with chronic NPU was carried out

Results

The duration of NPU was 604 ± 808 days, with a mean surface area of 4.6 ± 6.5 cm2, a mean depth of 1.04 ± 1.08 cm, and a mean volume of 5.9 ± 17.7 cm3. After a mean of 96 days of wearing a WCB (min 9D, max 664D, median 68D) the level of healing reached 83.6%, although 29 patients did not heal (16.4 %). The compliance was at 95%. NPUs with bigger volumes (p = 0.037) as well as those located at the heels (p = 0.004) had significantly lower healing levels.

Twenty one patients had moderate Peripheral Arterial Disease (PAD) (12%), and 24 patients were ostectomized for underlying osteomyelitis (14%), before inclusion. Moderate PAD (p = 0.970) or operated osteomyelitis (p = 0.128) did not modify the level of healing significantly, which were of 81% and 70.8% respectively.

Complications

12 ulcers due to the WCB (i.e. 7%) and 2 other ulcers being moderately infected, resulting in 2% of toe amputation, but there were no major amputation or phlebitis.

Conclusion

The treatment of old and deep NPUs of the diabetic foot by wearing a WCB without opening the boot prior to healing, offers very high ulcer recovery levels . WCB were changed in only 26 cases (14.6%). In addition,compliance was excellent and of order of 95%. Furthermore,moderate PAD or a recent osteoctomy did not affect the efficacy of WCB. This article is protected by copyright. All rights reserved.

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