Is Total Contact Cast with Opening a Window on the Ulcer Site Still a Contraindication for Diabetic Foot Wounds with Infection?

Abstract

Giriş: Ayak ülseri, diyabetin istenmeyen bir sonucudur. Azalan ağrı hissiyle birlikte nörolojik imbalans sonucu gelişen kas gücü değişiklikleri ile ayağın normal basma mekanizması bozulmakta, plantar yüzde anormal basınç artışı ve ülserler meydana gelmektedir. Uzun süreli ve geçmeyen ülserler, infeksiyon ve ampütasyona gidişi arttırmaktadır. Yapılan birçok çalışmada yara bölgesindeki basınç ve yükü azaltan yöntemlerin faydalı olduğu görülmüştür. Çalışmalarda altın standart uygulamanın total temas alçılama olduğu gösterilse de sirküler kapalı alçılama uygulaması infekte ve akıntılı olgularda yara yeri takibi yapılamayacağından önerilmemektedir. Alçıda yara yerinde pencere açılarak yaranın takibi mümkün olabilir. Bu çalışmada, infekte diyabetik ayak yarası olan olgularda, lezyon yerinde pencere açılarak yapılan alçılamanın etkinliğini değerlendirmeyi planladık.

Effectiveness of offloading interventions for people with diabetes‐related foot ulcers: A systematic review and meta‐analysis

“…One other controlled study, 57 and 1 non‐controlled study 169 reporting similar new lesion rates, found novel TCCs versus standard TCCs may cause moderate decreases in new lesions in people with infected DFU, but evidence is very uncertain (RR 0.57, 0.10–3.21; p = 0.52; N = 1; n = 76; Very low CoE).…”

“…One other controlled study 84 after adjusting for infection, and 3 non‐controlled studies reporting similar healed ulcer rates in those with infection, 97,168,169 found non‐removable knee‐high offloading devices versus removable offloading devices may cause large increases in proportions ulcers healed in people with infected DFU (adjusted OR 2.53, 1.19–5.35; p = 0.02; N = 1; n = 327; Low CoE; Note: study adjusted for age, sex, ulcer area, depth, peripheral artery disease, osteomyelitis).…”

“…Offloading interventions reported included non‐removable offloading devices, removable offloading devices, therapeutic footwear, felted foam, wheelchairs, Botulinum toxin injections, fibreglass heel cast, Achilles tendon lengthening and digital flexor tenotomy. Yet, of those, only 1 RCT 76 and 3 other controlled studies 35,57,84 reported outcomes in those with infections or ischaemia, while 4 non‐controlled studies 97,118,168,169 added relevant evidence. See the Comparisons 8 SoF table and forest plots in Supplementary File .…”

“…Ulcers healed One other controlled study 84 after adjusting for infection, and 3 non-controlled studies reporting similar healed ulcer rates in those with infection, 97,168,169…”

“…Twenty RCTs, 17,18,36,37,60,62,66,[68][69][70]73,[75][76][77][78][80][81][82][83] 12 other controlled studies 34,35,86,[88][89][90][91][92][93][94][95][96] and 13 non-controlled studies 51,98,99,101,107,110,118,119,133,136,162,169,170 reported on combinations of offloading interventions. The combinations included non-removable offloading devices (TCCs + cast shoe/ sole 17,68,73,86,98,99,…”