A Qualitative Study to Analyze the Effect of Plaster of Paris Slab on Wound Healing of Diabetic Foot Ulcers among Diabetics Attending Tertiary Hospital

  • Godwin Devadhas Packiaraj Assistant Professor, Department of General Surgery
  • Vignaradj Kirouchenaradj Assistant Professor, Department of General Surgery
  • V Shruthi Kamal Professor and Head, Department of General Surgery
  • B S Sundaravadanan Professor,Department of General Surgery
  • S Porchelvan Professor, Department of Biostatistics
Keywords: Diabetic foot, Plaster of paris slab, Various dressing

Abstract

Background: As diabetic foot is a very common in Indian population and the burden it exerts upon the health system is enormous
this study was undertaken. The study was carried out to evaluate the promotion in the rate of wound healing in patients with
diabetic foot ulcer undergoing saline dressing with posterior below knee plaster of paris slab (experimental arm) as against the
rate of wound healing with only saline.
Materials and Methods: The study was carried out in the Department of General Surgery in Saveetha Medical College and
Hospital for a period of 6 months with fifty patients included in the study. The patients were randomly divided into two groups,
one arm receiving saline dressing and plaster of Paris slab and other arm receiving only saline dressing. Patients were followed
every 2 weeks for a period of 6 weeks. The results were considered significant if P < 0.05.
Results: At the end of the study, patients receiving saline dressing with plaster of Paris slab demonstrated an accelerated wound
healing, with nearly 40% of patient in experimental group demonstrating wound size <30 cm2 as against control group with only
12% demonstrating wound size of <30 cm2. Each serial follow up demonstrated significant p value, favoring plaster of Paris slab
dressing over saline dressing alone.
Conclusion: Applying plaster of Paris slab to diabetic foot ulcers, apart from the fact of accelerated wound healing also offers
to be cost effective with reduced economical burden. Hence it has become a norm in my surgical unit to adopt this approach.

Author Biographies

Godwin Devadhas Packiaraj, Assistant Professor, Department of General Surgery

Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India,

Vignaradj Kirouchenaradj, Assistant Professor, Department of General Surgery

Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India

V Shruthi Kamal, Professor and Head, Department of General Surgery

Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India

B S Sundaravadanan, Professor,Department of General Surgery

Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India

S Porchelvan, Professor, Department of Biostatistics

Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India

References

1. Cuschieri A, Hanna G. Essential Surgical Practice: Higher
Surgical Training in General Surgery. United States: CRC
Press; 2015.
2. Cronenwett JL, Johnston KW. Rutherford’s Vascular Surgery
E-book. Netherlands: Elsevier Health Sciences; 2014.
3. Ghosh P, Valia R. Burden of diabetic foot ulcers in India:
Evidence landscape from published literature. Value Health
2017;20:A485.
4. Rastogi A, Bhansali A. Diabetic foot infection: An Indian
scenario. J Foot Ankle Surg 2016;3:71-9.
5. Peters EJ, Lipsky BA, Senneville É, Abbas ZG,
Aragón-Sánchez J, Diggle M, et al. Interventions in
the management of infection in the foot in diabetes:
A systematic review. Diabetes Metab Res Rev
2020;36:e3282.
6. Armstrong DG, Lavery LA. Evidence-based options for
off-loading diabetic wounds. Clin Podiatr Med Surg
1998;15:95-104.
7. Caputo GM, Ulbrecht JS, Cavanagh PR. The total contact
cast: A method for treating neuropathic diabetic ulcers. Am
Fam physician 1997;55:605-11.
8. Boulton AJ, Hardisty CA, Betts RP, Franks CI, Worth RC,
Ward JD, et al. Dynamic foot pressure and other studies as
diagnostic and management aids in diabetic neuropathy.
Diabetes Care 1983;6:26-33.
9. Zhang W, Li S, Zheng X. Evaluation of the clinical efficacy of
multiple lower extremity nerve decompression in diabetic
peripheral neuropathy. J Neurol Surg Part A Central Eur
Neurosurg 2013;74:96-100.
10. Lavery LA, Vela SA, Lavery DC, Quebedeaux TL. Total
contact casts: Pressure reduction at ulcer sites and the
effect on the contralateral foot. Arch Phys Med Rehabil
1997;78:1268-71.
11. Shaw JE, Hsi WL, Ulbrecht JS, Norkitis A, Becker MB,
Cavanagh PR. The mechanism of plantar unloading in total
contact casts: Implications for design and clinical use. Foot
Ankle Int 1997;18:809-17.
12. Dhalla R, Johnson JE, Engsberg J. Can the use of a terminal
device augment plantar pressure reduction with a total
contact cast? Foot Ankle Int 2003;24:500-5.
13. Kadel NJ, Segal A, Orendurff M, Shofer J, Sangeorzan B.
The efficacy of two methods of ankle immobilization in
reducing gastrocnemius, soleus, and peroneal muscle
activity during stance phase of gait. Foot Ankle Int
2004;25:406-9.
14. Greer N, Foman NA, MacDonald R, Dorrian J, Fitzgerald P,
Rutks I, Wilt TJ. Advanced wound care therapies for nonhealing diabetic, venous, and arterial ulcers:
A systematic review. Ann Intern Med 2013;159:
532-42.
15. Martí-Carvajal AJ, Gluud C, Nicola S, Simancas-Racines D,
Reveiz L, Oliva P, et al. Growth factors for treating
diabetic foot ulcers. Cochrane Database Syst Rev
2015;10:CD008548.
16. Dumville JC, Hinchliffe RJ, Cullum N, Game F, Stubbs N,
Sweeting M, et al. Negative pressure wound therapy for
treating foot wounds in people with diabetes mellitus.
Cochrane Database Syst Rev 2013;10:CD010318.
17. Liu J, Zhang P, Tian J, Li L, Li J, Tian JH, et al. Ozone therapy
for treating foot ulcers in people with diabetes. Cochrane
Database of Syst Rev 2015;10:CD008474.
18. Miller JD, Carter E, Shih J, Giovinco NA, Boulton AJ,
Mills JL, et al. How to do a 3-minute diabetic foot exam:
This brief exam will help you to quickly detect major risks
and prompt you to refer patients to appropriate specialists.
J Fam Pract 2014;63:646-54.
19. Kravitz SR, McGuire J, Shanahan SD. Physical
assessment of the diabetic foot. Adv Skin Wound Care
2003;16:68-75.
20. Evans KK, Attinger CE, Al-Attar A, Salgado C, Chu CK,
Mardini S, et al. The importance of limb preservation
in the diabetic population. J Diabetes Complications
2011;25:227-31.
21. Nabuurs-Franssen MH, Sleegers R, Huijberts MS, Wijnen W,
Sanders AP, Walenkamp G, et al. Total contact casting of
the diabetic foot in daily practice: A prospective follow-up
study. Diabetes Care 2005;28:243-7.
Published
2021-09-23
Section
Articles