Is Total Contact Casting Time Effective?

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Total contact casts provide “the patient and the clinician with a method of healing wounds quickly,” notes Jeffrey Jensen, DPM. Dr. Jensen says he and his colleagues use about 750 TCCs a year for patients.
A new randomized pilot trial says becaplermin gel may have promise in facilitating quicker healing in wounds that receive split thickness skin grafts.
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By Brian McCurdy, Associate Editor

Is total contact casting (TCC) too time-consuming a modality to be used in treating plantar foot ulcerations? It’s a prevailing question that has thwarted wider use of the modality. However, a new study recently presented at the Symposium on Advanced Wound Care (SAWC) attempts to shed new light on the “time-effectiveness” of TCC.
Study researchers concede there is a “relatively low use rate” of total contact casts for diabetic foot ulcers. Why? They say many do not use TCC because of the time involved in the process and frequent office visits. However, previous studies have shown that employing TCC has resulted in healing times of 38 to 60 days. Study co-author Jeffrey Jensen, DPM, calls TCC the “gold standard.”
“(TCC) provides the patient and the clinician with a method of healing wounds quickly,” says Dr. Jensen, a Diplomate of the American Board of Podiatric Surgery and Associate Professor at the University of Colorado Health Sciences Center. “This increases the clinician’s credibility in the community and they will receive more referrals because they are getting desirable outcomes.”
Addressing The Issue Of Time-Consuming Application
Dr. Jensen and his co-authors tracked 50 patients for the study and timed the applications of casting. The total average time a patient spent in the office for cast application following wound debridement was 29 minutes, according to the study. For the average patient, set-up and drying time totaled 21 minutes and 29 seconds. Application time, or actual physician time with the patient, was seven minutes and 32 seconds.
When using total contact casting, you can save time “by effectively utilizing and minimizing physician involvement, understanding the importance of appropriate application of the TCC and minimizing the number of visits to heal the wound,” the study concludes.

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