Removal of Plaster Casts

Plaster cast removal is a procedure in itself. The procedure involves risk of injury to patient and should be done with utmost care. Following equipments are necessary for removing a cast

• Scissors
• Benders
• Electric cutter
• Materials for washing limb
• Supportive bandages or appliances

• The limb in plaster should be supported by sandbags. As most casts are removed by bivalving down the lateral sides these areas should be easily accessible.

• The choice of apparatus depends on several factors. Unpadded and skin-tight casts are cut with plaster shears. Completely padded casts can be cut with an electric plaster cutter.

The noise of the electric cutter frightens some children, and so shears may be used.

• The procedure is explained to the patient, and the apparatus that you will be using should be demonstrated to make them feel at ease.
• The cast should be cut steadily and smoothly. it is good to converse with patient to divert his focus.

Cutting Plaster With Plaster Shears

The size of shears used depends on the size of the cast. Draw guidelines down the side of the cast making sure that the line does not run directly over any bony prominences.

The stockinette is snipped at the ends of the cast to allow the shears to be positioned above this lining materials. If stockinette has not been used, try to insert the blade between the plaster and the padding wool.

Insert the blade under the plaster, parallel to the skin with the handle held steadily in the vertical position. The other blade cuts through the cast from above, its handle should be parallel to the cutting line at rest. This is the starting position, and if the blades are incorrectly aligned, the lower blade will press into the flesh causing bruises or even lacerations.

After each cut the blades should be realigned before the next cut is made. This prevents the skin wrinkling in front of the shears.These manoeuvers are important because the thick tips of the blades can press uncomfortably on the surface of the skin.

Remove the shears after every four or six cuts. Clear any clogging in the blades and use the plaster benders to open out the cast.

Never try to cut round corners. Always remove the blades and cut from the opposite end of the line to meet the end of the cut already made.

When using shears, keep the elbows relatively still and apply the cutting force from the shoulder girdle and chest muscles. This gives a more controlled power and saves energy.

The use of the electric plaster cutter

The electric cutter must only be used to cut completely padded casts.

Warning: If blood has impregnated the padding, it will be hard. Skin could adhere to it and the blades may cut directly into the skin.

When using an electric cutter make sure that:
• No strain is put on the cable, and enough cable is available for the operation in hand.
• The cable does not come near the cutting blade.
• Some older types of cutters should not be used in the presence of oxygen or inflammable gasses.
• The operator’s hands are dry.
• The apparatus is serviced regularly.

Position the patient correctly, and mark the line of cutting. Reassure the patient by showing them that the cutting blade works by oscillation, and only cuts hard materials. The blade becomes hot when used and cutting must be stopped if the patient feels any scorching. Start cutting with reduced pressure after examining the area involved. Position the blade at the start of the guideline, apply gentle pressure and move the cutter smoothly along the line. When cutting starts, there is a tendency to grip the cutter which exerts unwanted pressure on the cast. A new operator should be trained to reduce the pressure by continuous but gentle wrist movements.

The electric cutter should always be used carefully especially near bony prominences such as the medial border of the foot leading to the big toe.

Care of the part released from the cast

The cast may have to be bivalved for inspection, X-ray purposes and sometimes for skin preparation prior to operation. In these circumstances, the halves are replaced and held by a bandage until further direction is given.

On removal of the parts of the cast, support the limb between sandbags and closely inspect if for any signs of trauma inflicted during the removal procedure.

Wash and dry the part.

Gentle massage with oil, or cream, may help to restore normal nutrition and elasticity to the skin. After extended period of immobility some oedema is likely initially if the part is dependent. Elastocrepe or other supporting bandage may be needed.

These should support the whole area released from the cast. The new support should be applied at once and in the case of upper and lower limbs the patient should be advised to resume normal activity gradually, and to rest the part at regular intervals while maintaining digital exercises when at rest.

When a plaster is removed before surgery, skin texture and nutrition should be improved by massage. This can help to stimulate good wound healing after elective surgery.

Patients should always be warned that they may be incapacitated without the cast for the first few days until the muscles have regained their tone.