Casts should be removed by professionals using appropriate equipment.
- Completion of the period of immobilization
- Numbness, tingling, increasing pain, or any other sensation indicating the cast is too tight
- Foreign body lodged between the skin and the cast
- Cast damage or wetness
- Concern about infection under the cast
- A date that is before the prescribed period of immobilization
- Injury to underlying skin (eg, abrasions, friction burn)
There are several different tools that can be used to remove a cast:
- Vibrating cast saw
- Cast spreader
- Blunt-tipped shears
Vibrating cast saws look like they could easily lacerate the skin, but they are quite safe.
- Use a sheet or drape to collect dust generated from cutting the casting material.
- If the cast saw has an attached vacuum hose, use it to collect the dust.
- Wear appropriate eye and respiratory protection to protect against flying cast debris.
- The patient should be positioned to provide the operator with optimal access to the extremity with the cast.
Step-by-Step Description of Procedure
- Introduce the vibrating cast saw to the patient, and touch it to your own palm to demonstrate that it does not hurt and will not cut the skin.
- Score the cast along its long axis.
- Continue cutting the cast in the channel created by scoring until the underlying padding is reached.
- Cut the padding and stockinette with blunt-tipped shears.
- Insert the cast spreader between the cut cast edges.
- Spread the cast apart using the cast spreader.
- Remove the cast.
- Clean the extremity of accumulated dried skin and oils using soap and water.
- Arrange or recommend appropriate physical therapy if needed (eg, for joint stiffness).
Warnings and Common Errors
- To avoid injury to the underlying skin, do not continue to apply pressure with the cast saw at the same location after cutting through the plaster or fiberglass.
Tips and Tricks
- Spreading the cast apart may be easier if both sides are cut rather than just one side.
- Brace part of the hand holding the cast cutter on the cast for better control.