Amputation prevention in a high-risk population through comprehensive wound-healing protocol.
This study included patients who presented with at least one chronic nonhealing ulcer and had been told by their referring physician that they would require amputation at the transmetatarsal level or higher. Hospital records of all patients seen in a comprehensive wound-healing clinic from August 1984 through January 1986 were reviewed. Twenty-four patients with 27 lower extremity ulcers were identified. An aggressive clinical wound care protocol, including arterial revascularization, control of infection, wound debridement, protective orthotics, and use of topically applied autologous Platelet-Derived Wound Healing Formula, was used to heal these chronic ulcers. With follow-up time ranging from 12 to 22 months, complete wound healing was obtained in 18 of 24 patients (75%), and limb salvage was obtained in 20 of 24 patients (83%). Of the 24 patients, 18 (75%) achieved wound healing and a functional limb; 16 of the 18 (67%) were ambulatory, and two (8%) had a functional limb for transfers, but were not ambulatory due to preexisting stroke. We conclude that an aggressive, comprehensive amputation intervention program can prevent the emotional, functional, and economic costs of limb loss in most high-risk patients.
Doucette
M M
MM
Department of Surgery and Physical Medicine, Minneapolis Veterans Medical Center.
Fylling
C
C
Knighton
D R
DR
D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D006801:Humans; D007866:Leg / Q000098:blood supply; D008722:Methods; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014652:Vascular Diseases / Q000601:surgery*; D014945:Wound Healing