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Alicia Lacy, LPN, removes a total contact cast used to help diabetic patients heal chronic foot wounds

Any time a patient has a chronic, systemic disease, physicians know they must be prepared to fight on a number of fronts. Certainly this is true of diabetics who also often face cardiovascular complications such as hypertension, vision impairment, neuropathy and wounds that just won’t heal.

Of the 18 million Americans with diabetes, approximately 15 percent of them will develop chronic wounds. The Baptist Hospital Wound Care & Hyperbaric Medicine Center, the area’s largest center of its kind both by size and patient volume, estimates that between 50-60 percent of their patients are diabetic.

Foot wounds especially are of grave concern for many with the chronic disease. Diabetics’ impaired circulation keeps blood and oxygen from getting to the extremities and can turn a small sore into a major problem … sometimes leading to amputation.

“One of our main goals at the center is limb salvage,” said Dr. Warren R. Patterson, medical director for the Baptist program.

The Baptist Hospital armamentarium includes nutritional education, lifestyle counseling, pharmacological support and advanced wound care techniques such as the total contact cast and hyperbaric chamber sessions.

When it comes to healing foot ulcers, Dr. Patterson said, “One of the big problems diabetics have is the weight of their entire body is transmitted to their foot while walking … there’s no way to offload the weight.”

With the total contact cast that problem is solved. The cone shape helps absorb the load. A bar on the bottom and a soft layer of foam placed between the wound and cast further alleviate pressure.

“It takes about 30 percent of the weight in the distal part of the leg and spreads it out circumferentially,” Patterson explained.

He added that the cast is changed weekly until about 14 days past the wound being healed, which allows time for the new tissue that has replaced the ulcer to become more stable. Most patients should expect to wear the cast for 8-12 weeks. Once the cast comes off, it’s typically recommended that the patient be custom fitted for diabetic shoes for future protection.

Patterson said the cast has been shown nationally to be a cost-effective alternative. Greg Pierce, the center’s program director, added that it’s clearly preferable — in terms of hard dollars and quality of life — to amputation.

“If you lose your limb, you lose your lifestyle,” he pointed out. “Unfortunately, a lot of foot ulcers will not heal and lead to amputation. Ten years ago, an amputation was $76,000 on the average.”

Another option for patients are the four hyperbaric chambers located at Baptist.

“It can be used concomitantly with the total contact cast,” Patterson noted. “It’s particularly good for diabetics because it energizes their white blood cells, making them more effective at digesting bacteria and laying down scar tissue.”

Patterson said once a patient is selected for the treatment, the patient is given 90-120 minutes of pressurized, 100 percent oxygen daily for 20-40 treatments. In normal breathing, a person takes in only 20 percent oxygen under one atmosphere, as opposed to 100 percent oxygen under two atmospheres in the hyperbaric chamber.

“It forces the oxygen to the damaged tissue much better and creates a better healing environment for the wound,” he said, adding that the chambers are also used for many other patients such as those suffering from soft tissue radiation damage or necrotizing fasciitis.

Pierce said that by using the advanced options at their disposal, the wound care center boasts an overall healing rate of 96.7 percent for all discharged patients. That figure represents a 5 percent jump since total contact casting was added in January.



November 2007

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