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The term “serial casting” refers to removing and then reapplying a cast over a period of time as the skin is becoming mature and fully healed. During serial casting, therapists position fingers, arms or legs to increase normal range of motion (ROM) over a joint and to provide pressure over scarring. From week to week, the cast is changed as tissue stretches and range of motion of that joint improves. In other words, the serial cast is used to remodel and lengthen the skin through the total contact of the cast. Skin length can increase or stretch when placed under a constant stretch; it tends to accommodate what is asked for by the firmer structure of the cast. The most damaging force to skin is not direct pressure but shearing forces. Because the casts conform so precisely, shear force from movement of the extremity under the cast is reduced. Serial casting is usually done from one month to six months after grafting. Initially, cast changes will occur more frequently (e.g. weekly); then, as skin is more durable, the cast changes and reapplications are spread out to every three or four weeks.
A long arm or leg cast is used even if the injury is a small hand or foot burn. Long casts are usually positioned with a bend at the elbow or knee joint to help prevent the cast from slipping or falling off.
Contact you doctor or burn rehabilitation therapist if you experience any problems with a cast and especially if any of the following signs or symptoms occur:
- Pain unrelieved by the prescribed medication
- Cast feels too snug or tight
- Cast becomes loose, broken or cracked
- Painful rubbing or pressure develops beneath the cast
- Continued coldness or a whitish or bluish discoloration of the casted limb
- Pain, numbness or continued tingling of the casted fingers or toes
- Unusually foul odor
- In infants or young children, crying which cannot be soothed by usual methods
Follow the doctors’ instructions carefully regarding physical activity.
Move fingers or toes frequently to reduce swelling and prevent joint stiffness.
If fitted with a cast walking shoe, wear it at all times except when sleeping or showering.
Avoid bumping or knocking the cast against hard surfaces.
Do not use anything to scratch under the cast because it may break the skin and cause an infection. If itching is a problem, tell your doctor.
Never stuff cotton or toilet tissue under the margins of the cast because it may fall into the cast and decrease circulation, causing serious medical problems.
If resting the cast on fine furniture, place a pad under it or wrap a cloth around it to avoid scratching the furniture.
Never trim or cut down the length of a cast.
Care of the skin under the cast is very important. Cleanse the area surrounding the cast daily with a cloth slightly dampened with water, taking care not to wet the cast. Do not use anything to scratch under the cast because it may break the skin and cause an infection. If itching is a problem, call your doctor.
Before the cast is applied, the skin is padded with a protective layer of cotton called webril. When the cast is removed, a specially designed saw will cut right through the cast but not the protected skin. Cast removal is usually a fast and painless process. However, the cast cutter is attached to a vacuum that removes the particles of plaster from cutting, so cast removal is a noisy process.
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