Football Dressing for Neuropathic Forefoot Ulcerations
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This prospective analysis is composed of patients from the Center For Wound Healing in Huntingburg, Ind, and the Wound Care Center in Jasper, Ind. The purpose of the study was to evaluate the effectiveness of the football dressing in healing diabetic forefoot ulcers of primarily neuropathic etiology. The patient population was carefully chosen to limit the role of cofactors, such as arterial insufficiency and altered glycemic control. Standard instruction regarding the importance of offloading, regular sharp debridement, moist wound healing, decreasing wound bacterial load, proper diet, and recognition of subjective symptoms consistent with infection was given to all patients. Patients were told to limit their ambulation to the truly necessary, although no assists (eg, crutches, wheelchair, cane) were employed.
Fifteen subjects were enrolled of which 7 patients required insulin and 8 required oral hypoglycemic medication to control their diabetes. All enrolled subjects were medicated for glycemic control prior to entering the study. No adjustments in glycemic control were made. All patients were deemed to have adequate arterial supply by the presence of 2 palpable pedal pulses. Alternatively, the presence of biphasic or triphasic waveforms on Doppler evaluation of a nonpalpable pedal pulse was also accepted. Sensory neuropathy was confirmed with monofilament screening. In all cases, there was absent sensation to a new 5.07 monofilament stimulus at more than 7/10 pedal sites. All wounds were graded with the University of Texas Health Science Center (UTHSC) wound classification system.33 Included were 1A, 1B, 2A, and 2B wounds. All 1A and 1B wounds were full thickness.
The wounds were subjected to once weekly sharp debridement. Any antibiotic use was employed orally and was deemed appropriate based on clinical signs of infection. The choice of antibiotic was guided by deep cultures post debridement and flushing of the wound. Primary wound dressings were a nonadherent layer followed by a silver-containing dressing and absorbent foam as indicated based on drainage. The football dressing consists of 3 rolls of 4" cast padding, 1 roll of 4" gauze, and 1 roll of 4" self-adherent wrap (Coban™ Self-Adherent Wrap, 3M Healthcare, St. Paul, Minn). The initial layer of cast padding is fan folded and applied in a longitudinal fashion. A second layer is then applied circumferentially about the forefoot. The final layer is applied from the forefoot proximally to the lower leg. A layer of 4" gauze is then applied over the entire dressing and is covered by a layer of self-adherent elastic wrap applied without tension (Figures 1–8). A standard post-operative shoe was dispensed for ambulation on the dressing.
Weekly measurements of wound length, width, and depth were taken post debridement. The wounds were photographed and described on the wound center’s standard wound evaluation form. The weekly change in wound surface area and volume was monitored as well as the total number of weeks to complete epithelization.
Statistical analysis. All descriptive data are presented as mean ± standard deviation. A t test was used to compare results of infected and noninfected wounds. For these analyses, an alpha level of 0.05 was considered statistically significant.
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