Rethinking Proper Patient Selection For Limb Salvage Interventions

By Ronald A. Sage, DPM

   Reducing the number of lower extremity amputations is a goal for all clinicians caring for patients with diabetes. In spite of this, the numbers of limb-threatening infections and subsequent amputations continue to rise each year. While medical and surgical interventions are frequently successful in facilitating limb salvage in patients facing amputation, failures in limb salvage attempts do occur. These failures result in multiple trips to the operating room, significant potential morbidity and prolonged disability.    In order to more accurately predict which patients are more likely to benefit from limb salvage attempts, we need to modify our patient selection criteria. Enhanced criteria may also help identify which patients would be better served by a single definitive procedure at a level likely to heal with a subsequent, timely initiation of rehabilitation. The following cases illustrate the point.

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