TCC as an acceptable treatment option for Diabetic Foot Ulcer (DFU) is gaining traction globally, thanks to the new, innovative and patient-focused products in the market.
About 85 % of the leg amputations in diabetic patients are preceded by DFU – a common wound complication in diabetic patients. Arteries of the leg are the most commonly affected regions. Decreased blood flow to the leg weakens the tissues and makes it vulnerable to external damage. Low blood supply creates a hypoxia environment delaying wound healing, leading to chronic wounds.
As in the case of all other wounds, infection control is crucial in DFU as well. Common bacteria that infect DFU are MRSA, VRE, Pseudomonas aeruginosa and Staphylococci sp. Infected DFU often shows symptoms of delayed wound healing and increases the risk of leg amputation. Antibiotic and antimicrobial-based dressings are therefore necessary to control and minimize infections.
Offloading is increasingly becoming an important treatment method for DFU as it reduces the wound pressure. Wheel chairs and crutches are typical examples of devices used for offloading post amputation to relieve pressure.
Underutilisation of Total Contact Cast despite its high healing potential
TCC, developed as an offloading device, is rated as the gold standard in the treatment of diabetic foot ulcer. It works by redistributing the pressure along the entire plantar aspect of the foot. TCC casting material is normally applied in contact with the contour of the foot.
The healing rate by the application of TCC is estimated to be approximately 90% in DFU patients, which is much higher than other commonly used/ prescribed treatment options, such as the removable air cast walker or shoe modality.
Despite clinical evidence indicating its efficacy, TCC offloading as an option for DFU treatment has not been widely adopted in many countries. Reluctance to use TCC is evident even in advanced countries such as USA.
A study by the U. S. Wound Registry indicated that only 3.7% of patients who can benefit from TCC actually receive it. Some of the highlighted factors responsible for this include lack of clinical expertise and patient’s commitment to treatment as well as application procedure complexities.
Application of TCC is time consuming and requires well-trained clinicians. Inappropriate application of TCC to the feet may lead to discomfort thereby worsening the wound. Many clinicians are reluctant to prescribe TCC due to its long wear time as TCC cannot be removed for 7 days post-cast.
An alternative to TCC is removable walker. As it can be removed at will, it facilitates daily inspection, dressing changes and early detection of infection. Removable walkers, however, face considerable patient compliance issues. Patient surveys have demonstrated that patients do not wear the cast 70% of the time they are walking!
In Malaysia also, acceptance of TCC as an offloading option for DFU is low. Need for long hours of staff training and the perception that TCC can delay healing have been the main factors limiting its market demand in Malaysia. Patient commitment is also a barrier for TCC in Malaysia as most patients tend to avoid it due to transportation issues and fear of falling.
TCC Demand to Grow at 13% CAGR in Malaysia
A recent study published by AcuBiz Consulting on advanced wound care markets in Malaysia indicates an increasing awareness of TCC in the DFU segment (https://acubiz.com.my/product/advanced-wound-care-markets-opportunities-malaysia/). Wound care practitioners have started accepting the benefits, which is helping to change the market perception slowly.
The above report identifies TCC as one of the fast growing segments of advanced wound care markets in Malaysia. The demand for TCC increased in the country by 13.8% in 2016 from that in 2015. It is forecasted to grow at a double digit CAGR of 13.2% between 2016 and 2021.
One of the key drivers of TCC demand is the introduction of TCC-EZ by Derma Sciences, Inc. This newer generation TCC offers easier application and removal with minimal training. Since it can be applied in about 15 minutes compared to 30-45 minutes of drying time for traditional TCC, hospitals and clinics are more open to adopt TCC-EZ. Concerns about storage space are also minimal since all the cast kit supplies fit in one box.
As awareness about TCC increases, its acceptance as an offloading device is expected to increase in Malaysia, which has a diabetic population of over 3 million. Considering the high prevalence of diabetes in Malaysia, the demand for TCC is expected to grow as product awareness and clinical acceptance increase.