ROUNDS RESPONSE.
Rounds is your vehicle for sharing your orthopaedic skills and experience. Your response to Rounds will be published in a future issue of Body Cast. We invite you to suggest questions for this column. Please address all submissions to: The Editor, Body Cast, 18 Wynford Drive, Suite 715A, North York, Ontario, M3C 3S2.

This Issue's Rounds Question -
Please tell us: Is it a necessary protocol to clean your scissors and cast saw blades?

(responses to be published in next issue)

In the last issue of Body Cast, Rounds asked: An 18-month-old child is in a Hip Spica for a fractured femur. Prior to his/her discharge from the hospital, you have been asked to petal the child’s cast. Explain cast petaling and what you will need.

The following responses were received:

From Lhea Burk:
“Cast petaling” mean you will cover the rough edges of the cast to protect the child’s skin. There are different kinds of adhesive padding. Moleskin is commonly used as adhesive padding. You cut petal-shaped strips (round edge) three to five inches in length and two to three inches in width, place around edges of cast (i.e. ankles, other edges) overlapping slightly, putting round edges inside cast. The cast will be petaled in hospital after cast is dry. At home, you will need to change petals or strips whenever they become wet or soiled.

From Mary Anne Lash:
Cast petaling is done for comfort and safety of the patient. As we all know, plaster and fibreglass products can be quite abrasive and cutting. The skin of the very young and elderly needs to be protected as it can be chafed or cut quite easily.

Petaling is a method of putting a barrier between the edges of the cast and the patient’s skin, hopefully to prevent breakdown. We use three-inch red waterproof tape.

Needed: 3” red waterproof tape, scissors.

Explain to patient or family what you plan to do and why. Take red tape and begin at finished edge of casting material on cast.

Place red tape 1.5’ above finished edge and 1.5’ below finished edge causing a turtle collar-type look. Go around the entire outer edge with one strip of tape. Example, around chest and back. Now fold the 1.5’ of red tape that is above the finished edge (turtle collar) into the inner side of cast edge. (Tape is now against inside of cast.) This makes a border between the inner and outer edge of cast, protecting the patient. Do this on all edges of cast.

I usually show the family this method and send them home with some extra tape. They are always encouraged and welcomed to call the clinic or come in if they have any problems.

From Kimberley Leslie:
Cast petaling refers to a particular method of taping the edges of the hip spica surrounding the buttocks and perineal area with waterproof tape. It is called petaling since the finished product looks similar to the petals of a flower. Cast petaling helps protect the cast from wetness. One-inch or two-inch rolls of waterproof tape are required for the task. A dozen or more pieces of tape will be required, each one approximately three inches long. One half of the tape is stuck to the outside of the cast while the other half is stuck to the underside of the cast by tucking it in with your fingers. It is important to make sure the tape is sticking to the cast underneath and not to the patient’s skin. You may need to press the patient’s skin down with your other hand to create enough space to tuck the tape in. The rest of the pieces are applied in a similar fashion, making sure to overlap the pieces to ensure a waterproof seal. Extra tape can be given to the parents to petal the cast at home should the cast require it.

From Gary Marshall:
A soft adhesive tape called moleskin is the preferred material used to petal a cast. Petal-shaped strips are cut about three to five inches in length and two to three inches in width. These strips are then placed around all the edges of the cast overlapping slightly. The moleskin may need to be replaced periodically due to soiling.

It is used to prevent skin irritation from the edges of the cast.

From Ranjana Pagay:
A spica cast is most often needed in infants with developmental hip dysplasia(DDH) and in infants/young children below the age of five or six with femur fractures, or after hip/pelvis surgery.

Most Spica casts today are made of fibreglass. To avoid skin problems, it is extremely important that the cast be kept as dry and clean as possible, which is challenging for all caregivers.

To help prevent skin breakdown, the spica cast is lined with Goretex Pantaloon liner. This helps protect the cast and padding from becoming soiled from moisture.

To prevent skin irritation around the edges, the cast will need to be prepared. This process is called “petaling”. A soft adhesive tape, called moleskin is most commonly used to prepare the cast. Petal-shaped strips are cut about three to five inches in length and two to three inches in width. They are then placed all around the edges of the cast overlapping slightly. The moleskin tape may need to be replaced if it becomes soiled or starts to fall off. A colourful fibreglass covering is often added to the casts before your infant/child is taken home.

The general rule of thumb is to keep the infant/child as normal as possible, and the cast as dry as possible.

From Tom Yorke:
Cast petaling on a hip spica cast is done to keep the cast clean and dry to avoid and prevent rough edges. What you need to petal a cast is petaling tape or waterproof tape, cut to the length of about four inches. You can attach the tape to the cotton liner already incorporated in the cast or you can add more padding or mohair. To petal the cast, you cut several strips of tape to the above-mentioned size and then you tuck one end of the tape under the edge of the cast and apply the tape to the lining of the cast. After doing this, you take the free end of the tape and apply it to the outside of the cast surface. This is done until you have a complete edge formed around the cast. All edges of the cast should be petaled, showing extra attention to the diaper area opening.

One special precaution should be noted: if the cast was lined with Gortex liner, the cast should not be petaled.

Answers were also received from Tony Bellon, James Carragher, Eric Christiansen, Adriad Crossman, Suzanne Groulx, Mary Haldane, Edd Hayes, Brian Lavallee, Cam Longphee, Lori MacDonald, Blair Matheson, Joe Maulucci, Javad Movasseli, Jim Pike, James Punwassie, Cheryl Rivers, Bert Sheppard, Angela Wentzell, Heather Wong and Neuville Yao.