Dear Oleg

In your case to minimise the Messaration and exudation you can make
a window on TCC over the wound and frequently change the dressing
and you will recieve a good result. You have to do a X-ray and see
the presense of osteomyelitis. It also may happen when the surgeon
amputate the toe he just disarticulate the toe and does not exise
the head of the metatarsal bone. If so you have to ask your surgeon
to remove the head of the metatarsal bone and continue treatment
with TCC, with window over the wound.
With best regards
Dr. Wadud--- In TheDiabeticFoot@yahoogroups.com, "Dr. Oleg
Udovichenko" <ovu_short@...> wrote:
>
> 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.
>