Wounds that won’t heal are a serious threat for patients with diabetes and diseases of the arteries and veins. When not proactively managed, wounds may lead to limb amputations. Saving limbs involves a multidisciplinary approach to care.
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Vascular surgeon Lee Kirksey, MD, is a leader in the Limb Salvage Program of the Cleveland Clinic Heart & Vascular Institute. In the program, he works alongside other vascular doctors as well as diabetologists, podiatrists, infectious disease and orthopaedic specialists to provide comprehensive wound care.
A serious case
Early this year, Dr. Kirksey began managing one of the most severe cases he has ever seen. A 54-year-old man came to him for a second opinion after being told that his foot should be amputated. The wound began with a small cut from the shower door. Within days, the infection had progressed and his toe turned black and his leg became swollen. Dr. Kirksey had tests done and they learned that the man had diabetes.
“By the time he came to see us, he was in tremendous pain and had a large foot abscess with bacteria in his bloodstream,” says Dr. Kirksey. “We could have performed a guillotine amputation at the ankle, which would have been the first step toward a below the knee amputation. But we had a long discussion and the patient decided we should do everything possible to avoid amputation and save his foot.”
Limb saving procedures
Dr. Kirksey did an extensive incision to drain the patient’s infection (debridement) and removed two of his toes. Blood flow was restored and he was placed in a negative pressure device. He underwent several more debridement procedures followed by weekly applications of synthetic skin grafts. Finally, Dr Kirksey performed a biologic skin graft, which has almost completely healed the wound.
During this time, the patient received expert medical care to get his diabetes under control and reduce his blood pressure. Now, six months later, the patient has lost 40 pounds and is going through rehabilitation and getting physical therapy to regain the strength that he lost.
About saving limbs
“This patient was committed to the process, and that’s what it takes,” Dr. Kirksey says. “Saving a limb doesn’t happen overnight, and it isn’t always the easiest course to take when a wound becomes severe. It requires a tremendous amount of resources and collaboration from a team skilled in limb salvage techniques.”
Saving a limb significantly improves a patient’s functional ability, and in many cases, it allows a patient to return to work and to continue living independently. “Amputees can be fitted for prosthetics,” says Dr. Kirksey, “but many patients will never approach their previous level of activity because they lack the strength and endurance to walk with a prosthetics. That is why our focus is on prevention and early identification in at risk-groups like people with diabetes, hypertension or renal failure.”
This means managing blood pressure and blood sugar through diet exercise and regular visits to the doctor. And before going through an amputation, it is so important to find out what options are available. This is when specialty programs like Cleveland Clinic’s Limb Salvage and Amputation Prevention program can provide comprehensive care and consultation.