Impact of Interdisciplinary System-Wide Limb Salvage Advisory Council on Lower Extremity Major Amputation

2021 ◽  
Author(s):  
Mehdi H. Shishehbor ◽  
Tarek A. Hammad ◽  
Tonia J. Rhone ◽  
Ahmad Younes ◽  
Norman Kumins ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Limb Salvage ◽  
Major Amputation ◽  
Advisory Council

scholarly journals Limb Salvage and Functional Outcomes following Free Tissue Transfer for the Treatment of Recalcitrant Diabetic Foot Ulcers

2018 ◽  
Vol 35 (02) ◽  
pp. 117-123 ◽  
Author(s):  
Jocelyn Lu ◽  
Michael DeFazio ◽  
Chrisovalantis Lakhiani ◽  
Michel Abboud ◽  
Morgan Penzler ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Limb Salvage ◽  
Diabetic Foot ◽  
Functional Outcomes ◽  
Free Tissue Transfer ◽  
Major Amputation ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Flap Survival ◽  
Foot Reconstruction

Background Recent evidence documenting high success rates following microvascular diabetic foot reconstruction has led to a paradigm shift in favor of more aggressive limb preservation. The primary aim of this study was to examine reconstructive and functional outcomes in patients who underwent free tissue transfer (FTT) for recalcitrant diabetic foot ulcers (DFUs) at our tertiary referral center for advanced limb salvage. Methods Between June 2013 and June 2016, 29 patients underwent lower extremity FTT for diabetic foot reconstruction by the senior author (K.K.E.). In all cases, microsurgical reconstruction was offered as an alternative to major amputation for the management of recalcitrant DFUs. Overall rates of flap survival, limb salvage, and postoperative ambulation were evaluated. The lower extremity functional scale (LEFS) score was used to assess functional outcomes after surgery. Results Overall rates of flap success and lower limb salvage were 93 and 79%, respectively. Flap failure occurred in two patients with delayed microvascular compromise. Seven patients in this series ultimately required below-knee amputation secondary to recalcitrant infection (n = 5), intractable pain (n = 1), and limb ischemia (n = 1). The average interval between FTT and major amputation was 8 months (r, 0.2–15 months). Postoperative ambulation was confirmed in 25 patients (86%) after a mean final follow-up of 25 months (r, 10–48 months). The average LEFS score for all patients was 46 out of 80 points (r, 12–80 points), indicating the ability to ambulate in the community with some limitations. Conclusion FTT for the management of recalcitrant DFUs is associated with high rates of reconstructive success and postoperative ambulation. However, several patients will eventually require major amputation for reasons unrelated to ultimate flap survival. These data should be used to counsel patients regarding the risks, functional implications, and prognosis of microvascular diabetic foot reconstruction.

Salvaging the ischemic transmetatarsal amputation through distal arterial reconstruction

1993 ◽  
Vol 83 (2) ◽  
pp. 87-90 ◽  
Author(s):  
FB Pomposelli ◽  
P Basile ◽  
DR Campbell ◽  
FW LoGerfo
Keyword(s):  
Lower Extremity ◽  
New England ◽  
Limb Salvage ◽  
Secondary Infection ◽  
Graft Patency ◽  
Major Amputation ◽  
Entire Group ◽  
Arterial Bypass ◽  
Dorsalis Pedis Artery ◽  
Transmetatarsal Amputation

From 1982 to 1991, 17 patients underwent a lower extremity arterial bypass to salvage an ischemic transmetatarsal amputation at the New England Deaconess Hospital. Eleven patients were male, and 16 had diabetes for an average of 29 years. The mean age was 71 years. Twelve patients presented with an ischemic ulcer, one had rest pain, and four underwent bypass for failure to heal a transmetatarsal amputation. Twelve patients presented with findings of secondary infection. All 17 patients underwent successful lower extremity bypass procedures to a variety of outflow vessels. Thirteen bypasses were to infrapopliteal arteries, including four to the dorsalis pedis artery. There were no perioperative deaths and all patients were discharged with patent grafts and healing limbs. Actuarial graft patency of the 14 vein grafts was 90% at 2 years. Actuarial limb salvage for the entire group was 93% at 2 years. Thirteen of the 14 patients who maintained patent grafts and healed their transmetatarsal amputations were ambulatory at their last known follow-up examination. Ischemic complications of previously created transmetatarsal amputations are uncommon. However, limb salvage attempts by lower extremity arterial bypass have a high likelihood of success. Major amputation in these patients should not be done without having first undergone a comprehensive vascular evaluation.

scholarly journals The Role of Lower Extremity Amputation in Chronic Limb-Threatening Ischemia

2020 ◽  
Vol 29 (03) ◽  
pp. 149-155
Author(s):  
Tanner I. Kim ◽  
Carlos Mena ◽  
Bauer E. Sumpio
Keyword(s):  
Lower Extremity ◽  
Limb Salvage ◽  
Major Amputation ◽  
Severe Form ◽  
Lower Extremity Amputation ◽  
Multidisciplinary Teams ◽  
Peripheral Artery ◽  
Artery Disease ◽  
Extremity Amputation

AbstractChronic limb-threatening ischemia (CLTI) is a severe form of peripheral artery disease associated with high rates of limb loss. The primary goal of treatment in CLTI is limb salvage via revascularization. Multidisciplinary teams provide improved care for those with CLTI and lead to improved limb salvage rates. Not all patients are candidates for revascularization, and a subset will require major amputation. This article highlights the role of amputations in the management of CLTI, and describes the patients who should be offered primary amputation.

Outcomes after Emergency Admission with a Diabetic Foot Attack Indicate a High Rate of Healing and Limb Salvage But Increased Mortality: 18-Month Follow-up Study

2020 ◽  
Author(s):  
Erika Vainieri ◽  
Raju Ahluwalia ◽  
Hani Slim ◽  
Daina Walton ◽  
Chris Manu ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Diabetic Foot ◽  
Emergency Admission ◽  
Arterial Disease ◽  
Major Amputation ◽  
Outcome Data ◽  
High Rate ◽  
Free Survival ◽  
Peripheral Arterial

Abstract Aim The diabetic foot attack (DFA) is perhaps the most devastating form of diabetic foot infection, presenting with rapidly progressive skin and tissue necrosis, threatening both limb and life. However, clinical outcome data in this specific group of patients are not available. Methods Analysis of 106 consecutive patients who underwent emergency hospitalisation for DFA (TEXAS Grade 3B or 3D and Infectious Diseases Society of America (IDSA) Class 4 criteria). Outcomes evaluated were: 1) Healing 2) major amputation 3) death 4) not healed. The first outcome reached in one of these four categories over the follow-up period (18.4±3.6 months) was considered. We also estimated amputation free survival. Results Overall, 57.5% (n=61) healed, 5.6% (n=6) underwent major amputation, 23.5% (n=25) died without healing and 13.2% (n=14) were alive without healing. Predictive factors associated with outcomes were: Healing (age<60, p=0.0017; no Peripheral arterial disease (PAD) p= 0.002; not on dialysis p=0.006); major amputation (CRP>100 mg/L, p=0.001; gram+ve organisms, p=0.0013; dialysis, p= 0.001), and for death (age>60, p= 0.0001; gram+ve organisms p=0.004; presence of PAD, p=0.0032; CRP, p=0.034). The major amputation free survival was 71% during the first 12 months from admission, however it had reduced to 55.4% by the end of the follow-up period. Conclusions In a unique population of hospitalised individuals with DFA, we report excellent healing and limb salvage rates using a dedicated protocol in a multidisciplinary setting. An additional novel finding was the concerning observation that such an admission was associated with high 18-month mortality, almost all of which was after discharge from hospital.

scholarly journals Norwegian trends in numbers of lower extremity revascularisations and amputations including regional trends in endovascular treatments for peripheral arterial disease: a retrospective cross-sectional registry study from 2001 to 2014

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e016210 ◽  
Author(s):  
Kjersti Wendt ◽  
Ronny Kristiansen ◽  
Kirsten Krohg-Sørensen ◽  
Fredrik Alexander Gregersen ◽  
Erik Fosse
Keyword(s):  
Lower Extremity ◽  
Arterial Disease ◽  
Major Amputation ◽  
Cross Sectional Study ◽  
Incidence Rates ◽  
Cross Sectional ◽  
Regional Trends ◽  
Treatment Knowledge ◽  
Patients With Diabetes ◽  
Peripheral Arterial

ObjectiveThe numbers of lower extremity revascularisations and amputations are insufficiently reported in Norway. To support future policy decisions regarding the provision of vascular treatment, knowledge of such trends is important.MethodsThis retrospective cross-sectional study from 2001 to 2014 used data from the Norwegian Patient Registry. The revascularisation treatments were categorised in multilevel, aortoiliac, femoral to popliteal and popliteal to foot levels and sorted as open, endovascular and hybrid. The sessions in amputations were divided in major (thigh and below knee) and minor (ankle, foot or digit). Incidence rates were assessed per 100 000 for patients in the age group>60 years. The diabetic prevalence was calculated and the endovascular numbers at the South-Eastern, Western, Central and Northern Norway Regional Health Authority were compared.ResultsThe overall revascularisation rates increased from 308.7 to 366.8 (p=0.02). Open revascularisations decreased from 158.9 to 98.7 (p<0.01) while endovascular revascularisations increased from 142.2 to 243.4 (p<0.01). Hybrid revascularisations increased from 7.4 to 24.8 (p<0.01). Major amputation rates decreased from 87.8 to 48.7 (p<0.01) while minor amputations increased from 12.3 to 19.6 (p=0.01). The diabetic percentages increased from 12.2 to 22.3 (p<0.01) in revascularisations, from 26.5 to 30.8 (p=0.02) in major amputations and from 43.0 to 49.3 (p=0.13) in minor. (p values refer to average annual changes.) The regional trends in endovascular treatments varied within and between the vascular groups.ConclusionFrom 2001 to 2014, the revascularisation rates increased due to the rise in endovascular procedures. Open revascularisations and major amputation rates decreased, minor increased. The regional variances in endovascular treatments indicate that the availability of this technology differed between the health regions of Norway. The increase in patients with diabetes requires continued awareness of diabetes and its complications.

Perforator Vessel Recipient Options in the Lower Extremity: An Anatomically Based Approach to Safer Limb Salvage

2010 ◽  
Vol 26 (07) ◽  
pp. 461-469 ◽  
Author(s):  
Nicholas Haddock ◽  
Evan Garfein ◽  
Derek Reformat ◽  
Elizabeth Hecht ◽  
Jamie Levine ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Limb Salvage ◽  
Perforator Vessel

Lower Extremity Amputation for Ischemia

2018 ◽  
Author(s):  
William C. Pevec
Keyword(s):  
Lower Extremity ◽  
Chronically Ill ◽  
Major Amputation ◽  
Postoperative Management ◽  
Functional Mobility ◽  
Knee Amputation ◽  
Below The Knee ◽  
Psychological Harm ◽  
Independent Ambulation ◽  
Chronic Arterial Occlusive Disease

Major amputations (proximal to the ankle) of the lower extremity are the manifestations of end-stage, nonreconstructable chronic arterial occlusive disease. A well-performed amputation provides the patient with the best prognosis for return to functional mobility. However, an amputation that fails to heal primarily may cause substantial physical and psychological harm to an already chronically ill patient. Minor amputations (at the toe or forefoot level) are not technically complex, but poor patient selection or technical imperfection can result in major amputation and loss of independent ambulation. In this chapter, selection of the level of amputation is reviewed; the methods to perform digital, forefoot, transtibial, and transfemoral amputations are presented; and postoperative management and potential complications are discussed.   Key Words: above-the-knee amputation, below-the-knee amputation, Guillotine amputation, ray amputation, transmetatarsal amputation, transphalangeal amputation This review contains 10 figures, 1 table and 22 references

Impact of Kidney Disease on Peripheral Arterial Interventions: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 51 (7) ◽  
pp. 527-533
Author(s):  
Mahesh Anantha-Narayanan ◽  
Azfar Bilal Sheikh ◽  
Sameer Nagpal ◽  
Kim G. Smolderen ◽  
Jeffrey Turner ◽  
...  
Keyword(s):  
Systematic Review ◽  
Lower Extremity ◽  
Meta Analysis ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Major Amputation ◽  
Early Mortality ◽  
Comorbid Condition ◽  
Increased Risk ◽  
Peripheral Arterial

Background: There are limited data on outcomes of patients undergoing peripheral arterial disease (PAD) interventions who have comorbid CKD/ESRD versus those who do not have such comorbid condition. We performed a systematic review and meta-analysis to analyze outcomes in this patient population. Methods: Five databases were searched for studies comparing outcomes of lower extremity PAD interventions for claudication and critical limb ischemia (CLI) in patients with CKD/ESRD versus non-CKD/non-ESRD from January 2000 to June 2019. Results: Our study included 16 observational studies with 44,138 patients. Mean follow-up was 48.9 ± 27.4 months. Major amputation was higher with CKD/ESRD compared with non-CKD/non-ESRD (odds ratio [OR 1.97] [95% confidence interval [CI] 1.39–2.80], p = 0.001). Higher major amputations with CKD/ESRD versus non-CKD/non-ESRD were only observed when indication for procedure was CLI (OR 2.27 [95% CI 1.53–3.36], p < 0.0001) but were similar for claudication (OR 1.15 [95% CI 0.53–2.49], p = 0.72). The risk of early mortality was high with CKD/ESRD patients undergoing PAD interventions compared with non-CKD/non-ESRD (OR 2.55 [95% CI 1.65–3.96], p < 0.0001), which when stratified based on indication, remained higher with CLI (OR 3.14 [95% CI 1.80–5.48], p < 0.0001) but was similar with claudication (OR 1.83 [95% CI 0.90–3.72], p = 0.1). Funnel plot of included studies showed moderate bias. Conclusions: Patients undergoing lower extremity PAD interventions for CLI who also have comorbid CKD/ESRD have an increased risk of experiencing major amputations and early mortality. Randomized trials to understand outcomes of PAD interventions in this at-risk population are essential.

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