Amputation not always poor outcome

HOLLYWOOD, Fla. — Amputation is never a preferred outcome, but sometimes it is not the worst outcome, a speaker said at the International Symposium on Endovascular Therapy (ISET).

Among patients with critical limb ischemia or other conditions that produce major leg and foot wounds, “there are data that show once you have one leg amputated, there’s a high likelihood that the other extremity is going to be at risk,” Gary W. Gibbons, MD, FACS, medical director, Center for Wound Healing, South Shore Health System and professor of surgery at Boston University School of Medicine, said during a presentation. “What we found was that instead of amputations, restoring foot perfusion and having a great group of podiatric surgeons doing local resections and keeping the foot healed” led to better outcomes.

However, Gibbons said, sometimes amputation is not a bad outcome, depending on what the goals are for the patient and their family.

“This has to be discussed with the patient and their family,” he said. “Are they wanting to maintain independence? Is the goal ambulation? Is it functionality? Is it pain reduction? It’s OK to do some form of amputation as long as the contralateral limb is OK. And if the contralateral limb is gone, I want to do everything I can because transferring in and out of a wheelchair may be preserving that patient’s life and functionality. What is the family’s perception of all this, as well as our perception as practitioners and caregivers?”

Gibbons noted that in his past experience, “a bypass did not have any greater risk than a major amputation. So, we were very aggressive when we needed to be.”

A major consideration should be how much tissue is left, he said.

“It’s one thing to preserve a foot, but if the patient isn’t going to be able to walk on it, or if it’s so disturbed anatomically, can you use bracing?” Gibbons said. “What are you doing for inserts and shoeing to keep that limb going? If we don’t protect the foot and do some kind of biomechanical stability, shoeing, inserts and braces, it’s not going to the matter because they’re going to walk it right into the ground.”

Biomechanical stability is especially important because “we’re not curing these people,” he said. “This is like cancer. And 50% of those people are going to be dead in 3 years. Instead of thinking cure, like they’re never going to have another ulcer, what about remission?” – by Erik Swain

Reference:

Gibbons GW. Deep Dive Session 3: Wound Care for the Interventionalist. Presented at: the International Symposium on Endovascular Therapy (ISET); Feb. 3-7, 2018; Hollywood, Fla.

Disclosure: Gibbons reports he consults for Alliqua, BSN, Organogenesis and Osiris, speaks for Alliqua, BSN, MiMedx, Organogenesis and Osiris, and receives grant support from Organogenesis and Osiris.