1. Patterson, Gregory K. MD, CWS
  2. Hall, Edward MD, FACS, CWS
  3. Sigler, Tere PT, CWS
  4. Sawyer, R. Allen PT, CWS
  5. Johnson, Pam RN
  6. Farmer, Mary RN

Article Content


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.