Avoiding Amputations

Major amputations are still essential in certain life-threatening situations or in cases of overwhelming infection or uncontrollable pain. But most patients would do anything to avoid this independence-robbing surgery. And the evidence shows that most amputations in patients with diabetes or other circulatory problems can indeed be prevented. These missed opportunities for prevention haunt today's grim statistics:

Every year, over 70,000 people with diabetes have a lower extremity amputation.
Every other hour in Pennsylvania, someone with diabetes loses a foot or leg.
Amputation rates are two to four times greater in blacks than whites

As diabetes prevalence grows, and as those with diabetes live longer, the tragedy of avoidable amputations will continue unless action is taken.

Take Control

Patients can lower their amputation risk by taking preventive steps. Prevention occurs at several levels depending on the patient's individual risks:

Primary Prevention

Stop Wounds Before They Happen

The best long-term hope for preventing foot problems in the greatest number of people is to avoid—or treat early and aggressively—the underlying circulatory disorder itself. This primary prevention includes, for example, a healthy diet and plenty of exercise to avoid obesity (a major factor in diabetes and PAD).

Quitting smoking is also critical to ensuring good blood flow to the extremities. For those with early signs of disease, treatment of high blood sugar (hyperglycemia), high blood pressure (hypertension), and high cholesterol (hypercholesterolemia) also prevents complications.

Finally, education on basic foot care, and proper footwear, to prevent blisters and wounds is crucial, as are regular foot exams by a doctor.

Secondary Prevention

Heal Wounds Quickly

When a patient actually develops a foot ulcer or wound, secondary prevention efforts become critical. Medical centers in many communities now have specialized comprehensive wound care centers for exactly this purpose.

After careful evaluation of the wound, standard therapies to speed healing and reduce pain might include: wound dressings, antibiotics, removal of dead tissue (debridement), skin grafts, hyperbaric oxygen therapy, special bracing or shoes for off-loading of pressure, physical therapy, and nutrition.

Ideally, all this care is coordinated by a professional foot-care team of podiatrists and certified nurse specialists with access to physician specialists and surgeons. The care assumes continuation of the primary prevention efforts.

Tertiary Prevention

Correct Severe Problems

Unfortunately, many patients have progressive worsening of their extremity wounds and circulation problems. Some patients simply delay too long before consulting a physician or comprehensive wound care center about their foot ulcer.

Others may have underlying vascular disease or other inherent health risks (older age, immune problems, mobility or cognitive issues) that elevate their complication risk for multiple or slow-healing wounds, chronic blood flow deficiencies, and/or subsequent infections.

Whatever their clinical history or prior treatment, these high-risk patients in imminent danger of losing a limb should be evaluated immediately by a specialty team of vascular surgeons and other medical and surgical specialists capable of new types of aggressive interventions at the tertiary prevention level.

Prevent Amputation

Recently, many positive steps have been taken to improve primary and secondary prevention—here at Temple and elsewhere locally, regionally, and nationally. For example, disease management and patient education programs for diabetes and PAD are increasingly common. Thankfully, comprehensive wound healing centers are also available in many communities today. Medicare and most private insurers now cover the essential twice-yearly foot exams and conventional wound care treatments offered by these centers.

But even as patients gain access to excellent primary and secondary prevention efforts, we can—and must—find a way to reduce needless amputations even faster. Especially here in the Philadelphia region where major amputation rates remain so high, we must go one step more and ensure that highest risk patients are now seen at the newly emerging tertiary level of amputation prevention—that is, at a program such as the Temple Limb Salvage Center.