Current Concepts In Treating Ischemic Foot Ulcers
- Volume 20 - Issue 3 - March 2007
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Dr. Allie strongly suggests a bypass or percutaneous interventional procedure prior to considering amputation unless an obvious abscess or necrotizing fasciitis is present. He also recommends conservative, limited amputations when indicated as these procedures give the patient maximum opportunity to preserve tissue and function. Although he has advocated systemic hyperbaric oxygen (HBO) therapy, Dr. Allie has found 70 to 80 percent of the elderly CLI patients will have a contraindication or will not tolerate systemic HBO (due to CHF, pulmonary issues, etc.). He relates positive experiences with local extremity or topical oxygen therapy, noting he is encouraged with recent work at Ohio State where researchers are trying to provide the “science” of why this therapy works.
Avoiding amputation is possible with newer endovascular therapies, according to Dr. Zarrinmakan. He says one should perform revascularization as soon as one diagnoses an ischemic ulcer.
Dr. Brenner notes that one always obtains the best results in diabetic ischemic feet with multidisciplinary collaboration, including cardiology, internal medicine, vascular specialists, interventional radiology and podiatry. As revascularization procedures improve, Dr. Brenner believes there will be more cases of successful diabetic limb salvage and lower amputation rates.
Dr. Allie is the Director of Cardiothoracic and Endovascular Surgery at Cardiovascular Institute of the South in Lafayette, La., and the Southwest Medical Center in Lafayette, La.
Dr. Brenner is a Fellow and Past President of the American Society of Podiatric Dermatology. He is also the President of the Institute of Diabetic Foot Research, and is on the medical staff of the Long Island Jewish Medical Center in New Hyde Park, N.Y.
Dr. Karlock (shown at the right) is a Fellow of the American College of Foot and Ankle Surgeons, and practices in Austintown, Ohio. He is a Clinical Instructor of the Western Reserve Podiatric Residency Program in Youngstown, Ohio. Dr. Karlock is a member of the Editorial Advisory Board for WOUNDS, a Compendium of Clinical Research and Practice.
Dr. Zarrinmakan is a Fellow of the American College of Surgery. He practices cardiothoracic and vascular surgery in Warren, Ohio.
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