Treatment of pressure ulcers by serial casting in patients with severe spasticity of cerebral origin.

Abstract

To assess the effectiveness of serial casting in the treatment of pressure ulcers caused by severe spasticity. Case series. A clinic for the rehabilitation of persons with neurologic disorders. Nine patients with 11 pressure ulcers resulting from severe cerebral spasticity, the ulcers being intractable to conventional management because of repeated friction and/or inaccessibility. Serial casting of the limb(s) with the pressure ulcer(s), with either fenestration or a cast arch providing access to the wound. Improved healing of pressure ulcers, as quantified with the National Pressure Ulcer Advisory Panel classification system. Within a mean of 4.6 weeks, 7 ulcers healed completely and 4 improved markedly. The casting caused no complications. Moreover, extension deficits improved markedly in all patients (105 degrees +/- 27 degrees to 17 degrees +/- 10 degrees ). Serial casting may be a valuable tool in the treatment of pressure ulcers at the extremities of patients with severe cerebral spasticity.