Sponge-incorporated VS Multilayer Padding Long Leg Cast to Prevent Pediatric Heel Pressure Injury: A Randomized Controlled Trial: Sponge-incorporated Cast to Prevent Pressure Injury

Tinh Laoharojanaphand; Chatupon Chotigavanichaya; Thanase Ariyawatkul; Jidapa Wongcharoenwatana; Perajit Eamsobhana

doi:10.33192/smj.v76i6.266370

Authors

Tinh Laoharojanaphand Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Chatupon Chotigavanichaya Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Thanase Ariyawatkul Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Jidapa Wongcharoenwatana Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Perajit Eamsobhana Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

DOI:

https://doi.org/10.33192/smj.v76i6.266370

Keywords:

long leg cast, cast complications, sponge-incorporated cast, pressure injury

Abstract

Objective: To measure and compare the incidence of cast-related pressure injuries at the heel between sponge-incorporated long leg cast and multilayer padding cast following orthopedic lower extremity surgery.

Materials and Methods: Patients aged 1 to 18 years who were scheduled for elective lower extremity soft tissue surgery were recruited. They were equally randomized into two groups: sponge padding cast (Group 1) and multilayer padding cast (Group 2). A multilayer padding cast, consisting of five layers of Webril®, was applied to the heel and bony prominence areas. At the 2nd and 4th weeks postoperatively, cast-related heel pressure injuries were evaluated using the 2016 National Pressure Ulcer Advisory Panel (NPUAP) staging system. Changes in alignment and other complications were also recorded.

Results: 100 patients were recruited. At two weeks postoperatively, the incidence of cast-related heel pressure injuries in Group 1 was 4/46 cases (8.7%), with all cases being stage 1. In Group 2, there were 6/54 cases (11.1%), with 3 cases in stage 1 and 3 cases in deep tissue pressure injury (p=0.479). At four weeks postoperatively, Group 1 had 6/46 cases (13%), with 4/46 cases (8.7%) being stage 1 and 2/46 cases (4.3%) being deep tissue pressure injuries. Group 2 had 6/54 cases (11.1%) (p>0.99), with all cases being stage 1. There was no statistical difference in loss of alignment. No serious complications, such as compartment syndrome or neurovascular injury, were found.

Conclusion: The incidence of cast-related heel pressure injury was comparable between sponge padding cast and a multilayer cotton padding cast.

Author Biography

Thanase Ariyawatkul, Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

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