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

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.