title: Minor amputation and palliative wound care as a strategy to avoid major amputation in patients with foot infections and severe peripheral arterial disease.
abstract: Foot infections occurring in patients with severe peripheral arterial disease (PAD) who are not considered candidates for revascularization and limb salvage efforts are generally treated with major amputations. Herein we describe our early experiences in managing foot infections with minor amputations and palliative wound care as a strategy to avoid the functional disability often associated with major amputations. Patients with severe PAD that underwent minor amputations and subsequent palliative wound care for moderate/severe infections were paired with age-matched controls with PAD that underwent primary major amputations for foot infections. Eleven patients who underwent minor amputations and palliative wound care of 13 limbs were compared to an age-matched cohort of 12 patients undergoing 13 major amputations.The median age was 80 years in both groups. Survival at 1 and 2 years did not differ significantly between groups. All patients who were ambulatory and/or independently living remained so following palliative management; in contrast, major amputation changed ambulatory status in 75% of patients and independent living status in 50%. Palliative management did not result in ascending/systemic sepsis or progressive necrosis. The need for reoperations was uncommon in both groups. In summary, minor amputations and operative drainage with subsequent palliative wound care appears to be a safe management option in patients with severe PAD and moderate or severe foot infections that are not candidates for revascularization. Palliative management may result in less functional impairment than major amputation.
authors: Baylor College of Medicine, Houston, TX, USA nbarshes@bcm.tmc.edu.
authors: Neal R
authors: NR
authors: Barshes
authors: Baylor College of Medicine, Houston, TX, USA.
authors: Benjamin
authors: B
authors: Gold
authors: Baylor College of Medicine, Houston, TX, USA.
authors: Aimee
authors: A
authors: Garcia
authors: Baylor College of Medicine, Houston, TX, USA.
authors: Carlos F
authors: CF
authors: Bechara
authors: Baylor College of Medicine, Houston, TX, USA.
authors: George
authors: G
authors: Pisimisis
authors: Baylor College of Medicine, Houston, TX, USA.
authors: Panos
authors: P
authors: Kougias
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000379:methods*; D017719:Diabetic Foot / Q000150:complications* / Q000601:surgery*; D006801:Humans; D007239:Infections / Q000150:complications* / Q000601:surgery*; D008875:Middle Aged; D010166:Palliative Care; D058729:Peripheral Arterial Disease / Q000150:complications* / Q000601:surgery*; D012720:Severity of Illness Index
keywords: diabetic foot infection; palliative care