Abstract

Problem: Diabetic patients have a special vascular disease process, below-the-knee or infratrifurcation small vessel disease, also known as medical clacific stenosis. When these patients present with nonhealing foot and leg wounds, they have a high rate of amputation.

Rationale: This case series demonstrates how an aggressive approach to vascular evaluation and intervention can prevent amputation and the subsequent radical lifestyle changes that amputation can bring.

Methodology: We present a case series of 9 limbs in 8 patients reconstructed with in situ saphenous vein distal bypass techniques for limb salvage. All patients had nonhealing full-thickness wounds or gangrene with indeterminate depth wounds, diabetes mellitus, and infratrifurcation peripheral vascular disease. All 8 patients had been considered for either a transtibial below-the-knee or transfemoral above-the-knee amputation before being considered for a distal reconstruction.

Results: 7 of the 8 patients (87.5%) have avoided amputation, for a limb salvage rate of 88.9%. Two of the 9 limbs (22.2%) still have open wounds. Both of these patients' wounds are currently healing with decreasing overall wound areas. The one limb in the series that was lost had a patent graft but developed a wound infection and sepsis, requiring amputation.

Conclusions: We feel that because of the morbidity, mortality, and severe lifestyle changes associated with limb amputation, all attempts at reconstruction for diabetic-associated infratrifurcation vascular disease should be attempted. The limb salvage rate of 88.9% is only achieved by a multidisciplinary approach to wound care and healing. This requires that a surgeon trained in these techniques be an active participant in the overall wound care program.

Section Description

The following abstracts will be presented during 2 oral abstract sessions at the 16th Annual Clinical Symposium on Advances in Skin & Wound Care.