1. Section Editor(s): Hess, Cathy Thomas BSN, RN, CWOCN

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Diabetic Foot Care

A study published in the March issue of Diabetes Care compared the effectiveness of a removable cast walker rendered irremovable by wrapping it with a single layer of fiberglass casting material (iTCC) with the total contact cast (TCC) in the treatment of diabetic neuropathic plantar foot ulcers. Results of the randomized trial indicated that the iTCC may be as effective, faster to place, easier to use, and less expensive than the TCC for this type of treatment.


To reach this conclusion, the researchers studied 41 consecutive diabetic patients with chronic, nonischemic, neuropathic plantar foot ulcers who were randomly assigned to 1 of 2 groups: iTCC or a standard TCC. The proportion of patients whose ulcers had healed within 12 weeks in the iTCC and TCC groups were 80% and 74%, respectively.


Survival analysis and complication rates were similar in both groups, with a trend toward greater benefit in the iTCC group. In addition, researchers found a lower cost associated with the use of the iTCC compared with the TCC.


Pressure Ulcers

Mechanically ventilated patients are vulnerable to developing dermal pressure ulcers, according to a study published in the February 2005 issue of Intensive and Critical Care Nursing. More than 1.5 million hospitalized patients develop dermal pressure ulcers annually. Researchers at the Ohio State University College of Nursing studied 40 patients from the intensive care unit of a Midwestern hospital in the United States to determine the prevalence of dermal pressure ulcers in patients receiving mechanical ventilation and to describe the relationship between systemic oxygenation, tissue perfusion, and the prevalence of dermal pressure ulcers.


Patients were recruited into the study after intubation and data were collected every other day until extubation, transfer, or death. Subjects were primarily Caucasian and had a mean age of 56.4 years. The sample had an even distribution of male and female patients. Variables included demographics; weight; serum albumin level; skin condition; and ventilatory, oxygenation, and perfusion status. The Braden Scale was used to measure the risk of skin breakdown, with breakdowns classified from Stages I to IV. Braden scores ranged from 6 to 23, with a score of 6 indicating high risk and a score of 23 indicating low risk.


Results showed that 20% of the sample developed dermal pressure ulcers. A Pearson's correlation identified significant links between the Braden score and mean arterial pressure, Paco2, largest weight fluctuation in a 3-day period, and change in weight from admission to discharge. Fluid shifts and fluid weight gain may be important predictors of dermal pressure ulcers not currently assessed clinically. The lowest Braden score was not significantly associated with the development of dermal pressure ulcers.




Katz IA, Harlan A, Miranda-Palma B, et al. A randomized trial of two irremovable off-loading devices in the management of plantar neuropathic diabetic foot ulcers. Diabetes Care. 2005;28:555-9.



Pender LR, Frazier SK. The relationship between dermal pressure ulcers, oxygenation and perfusion in mechanically ventilated patients. Intensive Crit Care Nurs. 2005 Feb;21(1):29-38.