Dear Colleagues,
If somebody uses non-removable cast share please with your
experience.
I have a type 1 DM patient with neuropathic 2B (UT) ulcer (see file
NR-TCC.jpg) which didn't heal more than 6 months (non-compliance to
off-load regimen was considered as the main reason of this).
According to recent studies of Amstrong, 2005 - 2/3 of patients with
removable casts/walkers wear them not constantly, so some patient
really need more aggressive off-load for healing.
So I applied non-removable TCC for 3 days and used combination of
dressings to provide maximum exudate retention capacity:
Promogran+Actisorb+PermaFoam (latter is a thick foam from P.Hartmann
with ability to release excess of fluid to the outer side). Wound
culture a week before this cast revealed MRSA, so Fusidic acid 500
mg 3 times daily per os was given.
But after opening of Non-rem TCC I observed intensive maceration and
slight enlargement of the ulcer (see file NR-TCC2.jpg).
What was wrong?
Could you advise me more effective strategy to deal with excessive
exudates?
Thank you beforehand,
Oleg Udovichenko.