Is Limb Salvage Practical In Patients With Diabetes And Renal Failure?
Can Multidisciplinary Clinics Facilitate Limb Salvage For These Patients?
This is where the multidisciplinary wound care clinic comes into play. Despite the discouraging opinion in the aforementioned literature, early action is the key to success in caring for patients with an at-risk limb. Early debridements, timely revascularization, control of blood glucose levels and care of ulceration when it first emerges are all steps that increase the probability that one may salvage the limbs of patients with diabetes and renal failure.14 Despite the decreased survival rates of this patient group, limb salvage through aggressive and timely treatment is justified.4,20 As major amputation results in greatly reduced life expectancy, there is much to gain in saving these patients’ limbs.14 The multidisciplinary foot clinic combines podiatry, endocrinology, plastic surgery, vascular surgery and wound care practices to create a comprehensive center for successful limb salvage in the patient with diabetes and renal failure. Treatments also include footwear education, antibiotics, frequent debridements, meticulous dressing changes and soft tissue adjunctive procedures that have improved limb salvage rates for this patient population.20,21 One study concludes: “The multidisciplinary diabetic foot clinic model provides an ideal setting for early intervention, treatment and assistance with preventive strategies.”17 The patient with diabetes and renal failure will never fare as well as patients who do not suffer from either disease. Nevertheless, multidisciplinary care focused on timely control and prevention of the advancement of foot disease should replace primary amputation for the properly selected patient with diabetes and renal failure. Ms. Kaylor is a Research Intern at Georgetown University Hospital in Washington, DC. Dr. Steinberg (pictured at right) is an Assistant Professor in the Department of Plastic Surgery at the Georgetown University School of Medicine in Washington, D.C. For further reading, see “Treating Lower Extremity Wounds In The Face Of Systemic Disease” in the January 2006 issue of Podiatry Today or check out the archives at www.podiatrytoday.com.