{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T08:59:46Z","timestamp":1777712386880,"version":"3.51.4"},"reference-count":39,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T00:00:00Z","timestamp":1774310400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The International Journal of Lower Extremity Wounds"],"abstract":"<jats:p>\n                    Total contact casting (TCC) is a well-established offloading strategy for the management of Charcot neuroarthropathy and plantar ulcer healing; however, its use after resolution of the acute phase of diabetic foot attack (DFA) remains limited in routine clinical practice, particularly in complex presentations associated with severe infection, edema, compartment syndrome, or necrotizing fasciitis. This study evaluated the role of the San Elian Total Contact Cast (TCC-SE1) as an adjunctive intervention to enhance wound healing during the post-acute phase following clinical remission of DFA. A pilot prospective, comparative, non-randomized observational study was conducted between April 2021 and December 2024, including 67 patients who achieved clinical stabilization after a DFA. Patients received adjunctive treatment with TCC-SE1 or conventional post-acute management. Baseline demographic and clinical characteristics, including the San Elian Wound Severity Score (SEWSS) and DFA type, were comparable between groups (p\u2009&gt;\u20090.05). All patients fulfilled SEWSS criteria for mild-to-severe diabetic foot infection according to IDSA. Mixed DFA\u2014characterized by infection, edema, and\/or Charcot neuroarthropathy\u2014were the most frequent type DFA (87%). Severe acute complications, including compartment syndrome and necrotizing fasciitis, required prior surgical control in 97% of cases. Patients with severe unsolved ischemia or high risk of major amputation were excluded. Complete ulcer remission was achieved in 82.3% of patients treated with TCC-SE1 compared with 63.6% in the control group (p\u2009=\u20090.04). Mean healing time was significantly shorter in the TCC-SE1 group, with a reduction of 7.4 weeks (p\u2009=\u20090.03), and final wound area was significantly smaller (mean difference 11.3\u2005cm\n                    <jats:sup>2<\/jats:sup>\n                    , p\u2009=\u20090.04). Kaplan\u2013Meier survival analysis demonstrated a significantly higher probability of earlier wound closure in the TCC-SE1 group compared with conventional management (log-rank p\u2009&lt;\u20090.001). Adjunctive use of TCC-SE1 after remission of complex DFA was associated with improved post-acute wound outcomes; these findings warrant confirmation in larger prospective studies.\n                  <\/jats:p>","DOI":"10.1177\/15347346261430319","type":"journal-article","created":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T09:19:39Z","timestamp":1774343979000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Improved Outcomes with Total Contact Cast After non-Ischemic Mixed Diabetic Foot Attack with Necrotizing Fasciitis and Compartment Syndrome: A Clinical Evaluation"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-9205-0906","authenticated-orcid":false,"given":"Elizabeth","family":"Zambrano-Loaiza","sequence":"first","affiliation":[{"name":"Research Group, Centro de Prevenci\u00f3n y Salvamento de Pie Diab\u00e9tico San Elian, Veracruz, M\u00e9xico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9437-8836","authenticated-orcid":false,"given":"Carolina","family":"Guapillo","sequence":"additional","affiliation":[{"name":"Research Group, Centro de Prevenci\u00f3n y Salvamento de Pie Diab\u00e9tico San Elian, Veracruz, M\u00e9xico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2212-5106","authenticated-orcid":false,"given":"Guillermo Guerrero","family":"Torres","sequence":"additional","affiliation":[{"name":"Research Group, Centro de Prevenci\u00f3n y Salvamento de Pie Diab\u00e9tico San Elian, Veracruz, M\u00e9xico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2498-4606","authenticated-orcid":false,"given":"Montserrat Hern\u00e1ndez","family":"Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Research Group, Centro de Prevenci\u00f3n y Salvamento de Pie Diab\u00e9tico San Elian, Veracruz, M\u00e9xico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3211-2069","authenticated-orcid":false,"given":"Gabriela Ver\u00f3nica","family":"Carro","sequence":"additional","affiliation":[{"name":"Research Group, Centro de Prevenci\u00f3n y Salvamento de Pie Diab\u00e9tico San Elian, Veracruz, M\u00e9xico"},{"name":"Hospital Nacional Prof. A. Posadas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5333-3595","authenticated-orcid":false,"given":"Carlos Alberto","family":"Carrillo Bravo","sequence":"additional","affiliation":[{"name":"Epidemiology Department, Sociedad Colombiana de Medicina Preventiva y Ortomolecular, Bogot\u00e1, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5267-4803","authenticated-orcid":false,"given":"Ferm\u00edn Rafael","family":"Mart\u00ednez-De-Jesus","sequence":"additional","affiliation":[{"name":"Research Group, Centro de Prevenci\u00f3n y Salvamento de Pie Diab\u00e9tico San Elian, Veracruz, M\u00e9xico"},{"name":"Hospital Nacional Prof. A. Posadas"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,3,24]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)67698-2"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1615439"},{"issue":"1","key":"e_1_3_2_4_2","article-title":"International consensus and practical guidelines on the management and prevention of the diabetic foot","volume":"16","author":"Apelqvist J","year":"2000","unstructured":"Apelqvist J, Bakker K, van Houtum WH, Nabuurs-Franssen MH, Schaper NC. International consensus and practical guidelines on the management and prevention of the diabetic foot. Diabetes Metab Res Rev. 2000;16(Suppl 1):S84-S92.","journal-title":"Diabetes Metab Res Rev"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis460"},{"key":"e_1_3_2_6_2","volume-title":"Clinical practice recommendations on the diabetic foot","author":"International Diabetes Federation","year":"2017","unstructured":"International Diabetes Federation. Clinical practice recommendations on the diabetic foot. International Diabetes Federation; 2017."},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/1534734618755582"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.24875\/CIRU.20000283"},{"issue":"2","key":"e_1_3_2_9_2","article-title":"Clinical practice recommendations for diabetic foot attack: This is how we do it: Guidelines from the Latin American diabetic foot association (ALAPID)","volume":"1","author":"Mart\u00ednez-De Jes\u00fas FR","year":"2025","unstructured":"Mart\u00ednez-De Jes\u00fas FR, Carro GV, Cendejas-Alatorre R, et al. Clinical practice recommendations for diabetic foot attack: This is how we do it: Guidelines from the Latin American diabetic foot association (ALAPID). Glob Wound Care J. 2025;1(2 Suppl 1):S1-S54.","journal-title":"Glob Wound Care J"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/1534734620931264"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1600673"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9610(00)00360-3"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1086\/511638"},{"issue":"1","key":"e_1_3_2_14_2","article-title":"Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update)","volume":"36","author":"Lipsky BA","year":"2020","unstructured":"Lipsky BA, Senneville E, Abbas ZG, et al. Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update). Diabetes Metab Res Rev. 2020;36(Suppl 1):e3280.","journal-title":"Diabetes Metab Res Rev"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.2697"},{"issue":"6","key":"e_1_3_2_16_2","first-page":"562","article-title":"Randomized clinical trial to compare total contact casts, healing sandals, and a shear-reducing removable boot to heal diabetic foot ulcers","volume":"142","author":"Lavery LA","year":"2007","unstructured":"Lavery LA, Higgins KR, La Fontaine J, Zamorano RG, Constantinides GP, Kim PJ. Randomized clinical trial to compare total contact casts, healing sandals, and a shear-reducing removable boot to heal diabetic foot ulcers. Arch Surg. 2007;142(6):562-567.","journal-title":"Arch Surg"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.28.3.555"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.7547\/87507315-92-7-405"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/1534734610371594"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0327601"},{"issue":"1","key":"e_1_3_2_21_2","article-title":"Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2019 update)","volume":"36","author":"Bus SA","year":"2020","unstructured":"Bus SA, Armstrong DG, Gooday C, et al. Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2019 update). Diabetes Metab Res Rev. 2020;36(Suppl 1):e3274.","journal-title":"Diabetes Metab Res Rev"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1177\/1534734615606534"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1177\/15347346211041452"},{"issue":"4","key":"e_1_3_2_24_2","first-page":"23","article-title":"Evaluation of the WIfI classification system in older patients with diabetes","volume":"8","author":"Vela-Orus MP","year":"2017","unstructured":"Vela-Orus MP, Iglesias-Soria T, Mart\u00ednez-Indart L, Arana-Arri E, Gaztambide-Saez S. Evaluation of the WIfI classification system in older patients with diabetes. Wounds Int. 2017;8(4):23-27.","journal-title":"Wounds Int"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3272"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1007\/s13410-017-0570-5"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1177\/1534734620930171"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1590\/1518-8345.7768.4722"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1111\/wrr.12289"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.37897\/RJMP.2021.2.21"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11247390"},{"key":"e_1_3_2_32_2","unstructured":"Ministry of Health Salvador. Lineamientos t\u00e9cnicos para el abordaje integral multidisciplinario e interinstitucional a las personas con pie diab\u00e9tico. San Salvador: Ministerio de Salud. Acuerdo N\u00b0 2736. 2021. Available at: http:\/\/asp.salud.gob.sv\/regulacion\/default.asp"},{"key":"e_1_3_2_33_2","unstructured":"Ministry of Health Chile. Technical Guidance: Comprehensive Management of the Diabetic Foot (San Eli\u00e1n System). Sub-Secretariat of Public Health Division of Prevention and Control of Diseases National Department of Non-Communicable Diseases Ministry of Health Chile. 2018. Available at: https:\/\/www.studocu.com\/cl\/document\/instituto-profesional-aiep\/salud-del-adulto-mayor\/orientacion-tecnica-manejo-integral-del-piediabetico-minsal-chile-2018\/9517158"},{"key":"e_1_3_2_34_2","volume-title":"Programa Nacional de Diabetes. Flujogramas","author":"Ministerio de Salud P\u00fablica y Bienestar Social","unstructured":"Ministerio de Salud P\u00fablica y Bienestar Social. Programa Nacional de Diabetes. Flujogramas. MSPBS; 2022 [citado 2026 Feb 15]. Disponible en: https:\/\/share.google\/K49h2pEFp2BpIedeT"},{"key":"e_1_3_2_35_2","unstructured":"Gu\u00eda Clinica para la Prevenci\u00f3n Diagn\u00f3stico y Tratamiento Multidisciplinario del Pie Diab\u00e9tico colegio m\u00e9dico del Per\u00fa. Clinical Guide for the Prevention Diagnosis and Multidisciplinary Treatment of Diabetic Foot. 2021. Available at: https:\/\/repositorio.cmp.org.pe\/handle\/20.500.12971\/43"},{"issue":"4","key":"e_1_3_2_36_2","first-page":"22","article-title":"Handling barriers to offloading the foot in patients with diabetes","volume":"24","author":"Chadwick P","year":"2021","unstructured":"Chadwick P. Handling barriers to offloading the foot in patients with diabetes. Diabet Foot J. 2021;24(4):22-28.","journal-title":"Diabet Foot J"},{"issue":"3","key":"e_1_3_2_37_2","first-page":"230949901880248","article-title":"Total contact casting versus traditional dressing in diabetic foot ulcers","volume":"26","author":"Singh B","unstructured":"Singh B, Pradhan A, Talukdar B. Total contact casting versus traditional dressing in diabetic foot ulcers. J Orthop Surg (Hong Kong). 2018 Sep-Dec;26(3):2309499018802483.","journal-title":"J Orthop Surg (Hong Kong)"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110079701801210"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcot.2019.01.012"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/76.3.296"}],"container-title":["The International Journal of Lower Extremity Wounds"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15347346261430319","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15347346261430319","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15347346261430319","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T10:05:14Z","timestamp":1777457114000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15347346261430319"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,24]]},"references-count":39,"alternative-id":["10.1177\/15347346261430319"],"URL":"https:\/\/doi.org\/10.1177\/15347346261430319","relation":{},"ISSN":["1534-7346","1552-6941"],"issn-type":[{"value":"1534-7346","type":"print"},{"value":"1552-6941","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,24]]},"article-number":"15347346261430319"}}