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Splitting plaster with a scalpel blade: A safe way to allow easy splitting of a plaster
Injury, Int. J. Care Injured (2008) 39, 368—370
www.elsevier.com/locate/injury
Splitting plaster with a scalpel blade: A safe way to allow easy splitting of a plaster E.J.P. O’Leary a,*, S. Griffin b, K.J. Tayton a a b
Royal Gwent Hospital, Cardiff Road, Newport, Gwent NP20 2UB, United Kingdom Ysbyty Gwynedd, Penrhosgarnedd, Bangor LL57 2PW, United Kingdom
Accepted 14 November 2007
KEYWORDS Plaster; Split; Scalpel
Summary Introduction: Splitting of a plaster cast is frequently required to accommodate postoperative limb swelling. Oscillating saws are often used but can cause injury and distress and cannot be used when the plaster is drying. At these times plaster shears are used. A safe technique is described which safely divides drying plaster using a sharp scalpel. Method: Plaster casts were applied to 40 modelling balloons, consisting of one roll of 3 in. and one roll of 4-in. plaster. The balloons had either two or four wool layers beneath the plaster. Ten from each group were split using our technique and 10 from each group were split with plaster shears. The number of balloons that were not burst during the splitting process was recorded. Results: Of the 20 plasters split with a scalpel, all of the balloons remained inflated. The balloons underneath two of the plasters with two layers of wool that were split using plaster shears burst during splitting. When the plasters split with a scalpel were dry they could be opened easily using cast spreaders and the wool cut with scissors without the balloons bursting. Conclusion: This is a safe and simple technique for splitting a drying plaster without the need for extra materials. It allows easy completion of the release with scissors alone should swelling of the soft tissues become excessive. The need for plaster shears or oscillating saws with the potential trauma associated with these established methods is eliminated. # 2007 Elsevier Ltd. All rights reserved.
Introduction
* Corresponding author at: 29 Severn Grove, Cardiff CF11 9EN, United Kingdom. Tel.: +44 7740 932 940. E-mail address: [email protected] (E.J.P. O’Leary).
Limb swelling following closed reduction of a fracture or open limb surgery is common, although subsequent development of compartment syndrome is fortunately rare. However, following the application of
0020–1383/$ — see front matter # 2007 Elsevier Ltd. All rights reserved. doi:10.1016/j.injury.2007.11.014
Splitting plaster with a scalpel blade a plaster, an otherwise troublesome but safe swelling has the potential to turn disastrous due to the rigidity of the plaster cylinder. In these cases the plaster needs to be promptly split to skin and then opened to relieve limb pressure. Previous work has shown that in order to significantly reduce the pressure in a limb the plaster and wool should to be split and separated along the length of the limb.4 This has been further quantified in a study on dogs by Garfin et al. who showed that casts were found to restrict compartment volume by approximately 40%, with the most significant reduction in pressures recorded after the cast was cut and spread. After cutting the underlying wool, the limb pressure dropped by a further 10—20%.5 Backslabs have been shown to be no better than full plasters in accommodating an increase in internal pressure.6 Plasters are frequently removed using an oscillating saw and these have been shown to cause injuries.1,2 The use of oscillating saws can also be distressing to young children. It is generally accepted that an oscillating saw cannot be used efficiently while a plaster is drying and this state persists for over 12 h. If a plaster needs to be split in this time plaster shears are used. A technique for splitting a damp plaster with a scalpel has been previously described but requires placing a length of plastic tubing in between the wool and plaster and cutting through the plaster onto the tubing.3 It was traditionally stated by older surgeons that splitting a drying plaster with a scalpel with no plastic is safe providing the wool is thick. This is based on the observation that drying plaster is easily cut by a fresh scalpel blade and thick wool is not. To test the truth of this claim a test was set up.
Method Plasters were put on 40 modelling balloons, each inflated to the same size. The plasters applied were the same used by the authors in their regular clinical practice, consisting of one roll of 3 in. and one roll of 4-in. plaster. Twenty of the balloons had two layers of wool beneath the plaster and 20 had four layers. The plaster was allowed to dry for 3—4 min until firm to the touch. Ten plasters from each group were split to wool with a scalpel (Swann Moreton size 22) whilst the plaster was drying. The scalpel was used to make a longitudinal slit down the length of the balloon, through the plaster to the wool below, without perforating the wool, leaving a 2 cm complete plaster bridge at the ends. Penetration of the blade through the plaster is easily felt by the operator and the wool is resistant to blade division. The
369 Table 1 Number of balloons burst following splitting with scalpel and shears Method of splitting
Wool layers
Intact
Burst
Scalpel
2 4
10 10
0 0
Shears
2 4
8 10
2 0
resultant gap can be widened with the back of the scalpel handle. This was performed by the two training surgeons, one a complete novice in the technique. Ten from each group were split in the conventional way with plaster shears. The number of balloons that were not burst during the splitting process was recorded.
Results Of the 20 plasters that were split with a scalpel, all of the balloons remained inflated (see Table 1). The balloons underneath two of the plasters with two layers of wool that were split using plaster shears burst during splitting. When the plasters split with a scalpel were dry they were easily opened using scissors and cast spreaders. The wool was then cut with scissors without the balloon bursting.
Discussion The technique described is a safe and quick way to split a fresh plaster. A similar technique is described whereby a length of anaesthetic tubing is placed on top of the wool and the plaster is split by cutting down onto the tubing with a scalpel.3 However we have found this to be fiddly, adding unnecessary time to the application process. In addition the extra materials may not always be available to the plastering surgeon. We have shown that by using two layers of wool there is no need for such methods to be used. When performing the split the layer of wool is easily felt by the operator. Of note, even the most junior trainee, with no previous experience of the technique performed the plaster splitting without bursting any balloons. This method, with at least four layers of wool is used now by all of the authors in their practice. The use of four layers is for safety. In our experience there have been no injuries to patients using this technique. The technique described avoids the need for traditionally used equipment such as the oscillating
370 saw and plaster splitters. Oscillating saws have been shown to cause burns and abrasions.1,2 In one study, the cause of the injury was the removal of a cast by an inexperienced or ill-trained user, or a blunt saw blade.1 In children the use of these methods can be particularly distressing. Plaster shears can be awkward to use and in our series caused two balloons to burst.
Conclusion We demonstrate a quick, safe, simple and neat technique for splitting a nearly dry plaster. The subsequent release is easily completed with scissors alone should soft tissue swelling become excessive. This eliminates the need for plaster shears or oscillating saws and the potential trauma, noise and distress associated with these established methods which is a particular problem in paediatric cases.
E.J.P. O’Leary et al.
Conflicts of interest The authors confirm that there are no conflicts of interest.
References 1. Ansari MZ, Swarup S, Ghani R, Tovey P. Oscillating saw injuries during removal of plaster. Eur J Emerg Med 1998;5(1):37—9. 2. Bingfold AC. On splitting plasters. J Bone Joint Surg Br 1979;61:294—5. 3. Garfin SR, Mubarak SJ, Evans KL, et al. Quantification of intracompartmental pressure and volume under plaster casts. J Bone Joint Surg Am 1981;63(3):449—53. 4. Henderson JJ, Wallace WA, Bowker P. Burns from a plaster saw blade. J R Coll Surg Edinb 1986;31(5):305—7. 5. Nunez VA, Arnander MWT. An effective and easy method of splitting damp Plaster of Paris casts. Ann R Coll Surg Eng 2006;88(5):505. 6. Younger ASE, Curran P, McQueen MM. Backslabs and plaster casts: which will best accommodate increasing intracompartmental pressures? Injury 1990;21:179—81.
www.elsevier.com/locate/injury
Splitting plaster with a scalpel blade: A safe way to allow easy splitting of a plaster E.J.P. O’Leary a,*, S. Griffin b, K.J. Tayton a a b
Royal Gwent Hospital, Cardiff Road, Newport, Gwent NP20 2UB, United Kingdom Ysbyty Gwynedd, Penrhosgarnedd, Bangor LL57 2PW, United Kingdom
Accepted 14 November 2007
KEYWORDS Plaster; Split; Scalpel
Summary Introduction: Splitting of a plaster cast is frequently required to accommodate postoperative limb swelling. Oscillating saws are often used but can cause injury and distress and cannot be used when the plaster is drying. At these times plaster shears are used. A safe technique is described which safely divides drying plaster using a sharp scalpel. Method: Plaster casts were applied to 40 modelling balloons, consisting of one roll of 3 in. and one roll of 4-in. plaster. The balloons had either two or four wool layers beneath the plaster. Ten from each group were split using our technique and 10 from each group were split with plaster shears. The number of balloons that were not burst during the splitting process was recorded. Results: Of the 20 plasters split with a scalpel, all of the balloons remained inflated. The balloons underneath two of the plasters with two layers of wool that were split using plaster shears burst during splitting. When the plasters split with a scalpel were dry they could be opened easily using cast spreaders and the wool cut with scissors without the balloons bursting. Conclusion: This is a safe and simple technique for splitting a drying plaster without the need for extra materials. It allows easy completion of the release with scissors alone should swelling of the soft tissues become excessive. The need for plaster shears or oscillating saws with the potential trauma associated with these established methods is eliminated. # 2007 Elsevier Ltd. All rights reserved.
Introduction
* Corresponding author at: 29 Severn Grove, Cardiff CF11 9EN, United Kingdom. Tel.: +44 7740 932 940. E-mail address: [email protected] (E.J.P. O’Leary).
Limb swelling following closed reduction of a fracture or open limb surgery is common, although subsequent development of compartment syndrome is fortunately rare. However, following the application of
0020–1383/$ — see front matter # 2007 Elsevier Ltd. All rights reserved. doi:10.1016/j.injury.2007.11.014
Splitting plaster with a scalpel blade a plaster, an otherwise troublesome but safe swelling has the potential to turn disastrous due to the rigidity of the plaster cylinder. In these cases the plaster needs to be promptly split to skin and then opened to relieve limb pressure. Previous work has shown that in order to significantly reduce the pressure in a limb the plaster and wool should to be split and separated along the length of the limb.4 This has been further quantified in a study on dogs by Garfin et al. who showed that casts were found to restrict compartment volume by approximately 40%, with the most significant reduction in pressures recorded after the cast was cut and spread. After cutting the underlying wool, the limb pressure dropped by a further 10—20%.5 Backslabs have been shown to be no better than full plasters in accommodating an increase in internal pressure.6 Plasters are frequently removed using an oscillating saw and these have been shown to cause injuries.1,2 The use of oscillating saws can also be distressing to young children. It is generally accepted that an oscillating saw cannot be used efficiently while a plaster is drying and this state persists for over 12 h. If a plaster needs to be split in this time plaster shears are used. A technique for splitting a damp plaster with a scalpel has been previously described but requires placing a length of plastic tubing in between the wool and plaster and cutting through the plaster onto the tubing.3 It was traditionally stated by older surgeons that splitting a drying plaster with a scalpel with no plastic is safe providing the wool is thick. This is based on the observation that drying plaster is easily cut by a fresh scalpel blade and thick wool is not. To test the truth of this claim a test was set up.
Method Plasters were put on 40 modelling balloons, each inflated to the same size. The plasters applied were the same used by the authors in their regular clinical practice, consisting of one roll of 3 in. and one roll of 4-in. plaster. Twenty of the balloons had two layers of wool beneath the plaster and 20 had four layers. The plaster was allowed to dry for 3—4 min until firm to the touch. Ten plasters from each group were split to wool with a scalpel (Swann Moreton size 22) whilst the plaster was drying. The scalpel was used to make a longitudinal slit down the length of the balloon, through the plaster to the wool below, without perforating the wool, leaving a 2 cm complete plaster bridge at the ends. Penetration of the blade through the plaster is easily felt by the operator and the wool is resistant to blade division. The
369 Table 1 Number of balloons burst following splitting with scalpel and shears Method of splitting
Wool layers
Intact
Burst
Scalpel
2 4
10 10
0 0
Shears
2 4
8 10
2 0
resultant gap can be widened with the back of the scalpel handle. This was performed by the two training surgeons, one a complete novice in the technique. Ten from each group were split in the conventional way with plaster shears. The number of balloons that were not burst during the splitting process was recorded.
Results Of the 20 plasters that were split with a scalpel, all of the balloons remained inflated (see Table 1). The balloons underneath two of the plasters with two layers of wool that were split using plaster shears burst during splitting. When the plasters split with a scalpel were dry they were easily opened using scissors and cast spreaders. The wool was then cut with scissors without the balloon bursting.
Discussion The technique described is a safe and quick way to split a fresh plaster. A similar technique is described whereby a length of anaesthetic tubing is placed on top of the wool and the plaster is split by cutting down onto the tubing with a scalpel.3 However we have found this to be fiddly, adding unnecessary time to the application process. In addition the extra materials may not always be available to the plastering surgeon. We have shown that by using two layers of wool there is no need for such methods to be used. When performing the split the layer of wool is easily felt by the operator. Of note, even the most junior trainee, with no previous experience of the technique performed the plaster splitting without bursting any balloons. This method, with at least four layers of wool is used now by all of the authors in their practice. The use of four layers is for safety. In our experience there have been no injuries to patients using this technique. The technique described avoids the need for traditionally used equipment such as the oscillating
370 saw and plaster splitters. Oscillating saws have been shown to cause burns and abrasions.1,2 In one study, the cause of the injury was the removal of a cast by an inexperienced or ill-trained user, or a blunt saw blade.1 In children the use of these methods can be particularly distressing. Plaster shears can be awkward to use and in our series caused two balloons to burst.
Conclusion We demonstrate a quick, safe, simple and neat technique for splitting a nearly dry plaster. The subsequent release is easily completed with scissors alone should soft tissue swelling become excessive. This eliminates the need for plaster shears or oscillating saws and the potential trauma, noise and distress associated with these established methods which is a particular problem in paediatric cases.
E.J.P. O’Leary et al.
Conflicts of interest The authors confirm that there are no conflicts of interest.
References 1. Ansari MZ, Swarup S, Ghani R, Tovey P. Oscillating saw injuries during removal of plaster. Eur J Emerg Med 1998;5(1):37—9. 2. Bingfold AC. On splitting plasters. J Bone Joint Surg Br 1979;61:294—5. 3. Garfin SR, Mubarak SJ, Evans KL, et al. Quantification of intracompartmental pressure and volume under plaster casts. J Bone Joint Surg Am 1981;63(3):449—53. 4. Henderson JJ, Wallace WA, Bowker P. Burns from a plaster saw blade. J R Coll Surg Edinb 1986;31(5):305—7. 5. Nunez VA, Arnander MWT. An effective and easy method of splitting damp Plaster of Paris casts. Ann R Coll Surg Eng 2006;88(5):505. 6. Younger ASE, Curran P, McQueen MM. Backslabs and plaster casts: which will best accommodate increasing intracompartmental pressures? Injury 1990;21:179—81.