Name of the Procedure:

Removal or Bivalving of Gauntlet, Boot, or Body Cast

Summary

The procedure involves removing or making a split (bivalve) in a cast that encompasses the arm, leg, or entire body to either alleviate pressure, enable inspection or treatment of the underlying skin, or transition to a different type of immobilization.

Purpose

The procedure is performed to relieve complications such as swelling, skin irritation, infection, or discomfort associated with an existing cast. The goal is to ensure the patient’s safety and comfort while maintaining the necessary immobilization for healing.

Indications

• Increased pain or discomfort under the cast
• Visible signs of reduced circulation (e.g., swelling, color changes in extremities)
• Signs of infection (e.g., unusual odor, discharge)
• Need for medical inspection or intervention not possible with the cast intact

Preparation

• Patients may need to avoid certain medications that could increase the risk of bleeding (consult with a healthcare provider).
• No fasting or significant preparation is typically required.
• Diagnostic checks to ensure it is safe to proceed, like assessing circulation and looking for signs of complications.

Procedure Description

1. Explanation and Consent: The procedure is explained, and consent is obtained.
2. Positioning: The patient is positioned comfortably to allow access to the casted area.
3. Cutting Tools: Oscillating saws or similar cutting tools are used to carefully cut through the cast material.
4. Splitting or Removal: If bivalving, two long parallel cuts are made, creating a split; the cast is then gently widened. If removing, additional cuts may be needed to fully detach the cast.
5. Inspection and Care: The underlying skin is inspected for any issues, and appropriate care or dressing is applied.
6. Reapplication: If necessary, a new cast or alternative immobilization device is applied.

Tools and Equipment:

• Oscillating saw
• Cast spreaders
• Protective padding
• Scissors

Anesthesia or Sedation:

• Typically not required, but local anesthesia may be used in specific cases.

Duration

The procedure usually takes about 15 to 30 minutes.

Setting

The procedure is typically performed in an outpatient clinic, doctor’s office, or hospital setting.

Personnel

• Orthopedic physician or surgeon
• Orthopedic technician or nurse

Risks and Complications

• Minor cuts or abrasions from the saw
• Potential discomfort during the removal
• Rare risk of further injury to the bone or limb

Benefits

• Relief from discomfort and swelling
• Reduced risk of complications such as skin infections or circulation issues
• Allows for necessary medical inspections or interventions

Recovery

• Post-procedure instructions may include keeping the area clean and dry.
• Follow-up appointments may be scheduled for further inspection or reapplication of casts.
• Patients typically resume normal activities immediately unless a new cast or splint is applied, which might come with restrictions.

Alternatives

• Splinting or bracing as an initial treatment.
• Medications to manage pain and swelling as temporary alternatives.
• Pros and Cons: Surgery might offer a more long-term solution for severe cases but comes with higher risks compared to cast removal or bivalving.

Patient Experience

During the procedure, patients may feel vibrations and hear noises from the saw, which can be startling but are generally not painful. Continuous reassurance and communication help manage any anxiety. Post-procedure, patients might experience initial relief followed by mild soreness or stiffness. Pain management typically involves over-the-counter pain relievers as needed.