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

Objective: To assess the effectiveness of serial casting in the treatment of pressure ulcers caused by severe spasticity. Design: Case series, Setting: A clinic for the rehabilitation of persons with neurologic disorders. Patients: 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. Intervention: Serial casting of the limb(s) with the pressure ulcer(s), with either fenestration or a cast arch providing access to the wound. Main Outcome Measures: Improved healing of pressure ulcers. as quantified with the National Pressure Ulcer Advisory Panel classification system. Results: 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 (105degrees +/- 27degrees to 17degrees +/- 10degrees). Conclusion: Serial casting may be a valuable tool in the treatment of pressure ulcers at the extremities of patients with severe cerebral spasticity.