Current SALSA Research Efforts To Preserve The Pedal Peninsula

David G. Armstrong DPM MD PhD
10/2/09 | 4107 reads | 0 comments
Greetings from the Southern Arizona Limb Salvage Alliance (SALSA). Joseph Mills, MD, and I recently did an interview with one of our professional magazines and we were reflecting on the unique nature of the diabetic foot. The diabetic foot is at the end of what I refer to as an “anatomic peninsula.” For that reason, the diabetic foot is hostage to the supply from the “anatomic mainland.” Read More.

Wound Chemotherapy: Can It Help Facilitate Optimal Outcomes?

David G. Armstrong DPM MD PhD
8/18/09 | 3101 reads | 0 comments
At the Southern Arizona Limb Salvage Alliance (SALSA), we are frequently saddled with the most complex patients (and wounds) I have worked with in my career. Our "Toe and Flow" philosophy has been evolving to develop what we call “wound chemotherapy.” Lately, we have been very active in modifying many of the techniques first described by Wim Fleischmann, MD, PhD, and others to provide active matrix management (negative pressure wound therapy) with other chemotherapeutic tools (i.e. antimicrobials/antiseptics, analgesics, etc.) to manipulate the wound environment. Read More.

SALSAisms: Lingo From The University Of Arizona's "Toe And Flow" Service

David G. Armstrong DPM MD PhD
7/14/09 | 3847 reads | 1 comments
On our "toe and flow" service at the Southern Arizona Limb Salvage Alliance (SALSA), we often operate in close quarters. This has led to many appellations for and colloquialisms used by various team members. Here is a partial (and running) list: 1. Toe Bless Oblige: The obligation to improve foot care 2. Podshine 3. Der DopplerGanger: Referring to one's vascular partner 4. Sir I-Pod: International podiatrist 5. PodCaster 6. Toe Mechanic 7. Podiatric physician extender: Given to our vascular surgical team Read More.

Raising Questions About The Treatment Of MRSA In Hospitals

David G. Armstrong DPM MD PhD
6/16/09 | 2609 reads | 0 comments
I am fascinated at the current nationwide trend we see in our hospitals toward precautions for methicillin resistant Staphylococcus aureus (MRSA). Much of this trend in the United States has been sparked by last year's “present on admission” criteria from the Centers for Medicaid and Medicare Services (CMS) that limited reimbursement for the increased complexity of treating these patients if the infection was not “present on admission.” Read More.

Does Your Hospital Have A DRRAFT?

David G. Armstrong DPM MD PhD
5/20/09 | 2464 reads | 0 comments
In the ongoing collaboration between the Infectious Diseases Society of America (IDSA) ( and the Southern Arizona Limb Salvage Alliance (SALSA) (, we have proposed the following key skill set for any multidisciplinary team dedicated to amputation prevention. We refer to this team as the Diabetic Rapid Response Acute Foot Team (DRRAFT). Here are the key skills for such a team. Read More.

Modified SALSAstand Fixation/Offloading For TMAs And Fragile Flaps

David G. Armstrong DPM MD PhD
4/10/09 | 3269 reads | 0 comments
Many clinicians have offered means of offloading the posterior diabetic foot both with and without internal fixation. We offer a modification of a post technique described by Saul Trevino, MD. In this modified technique, we reinforce the posts with a posterior distal to proximal anterior hypotenuse, using the Hoffman II Modular Fixation System (Stryker Orthopaedics) in a patient with end-stage renal disease and a gangrenous forefoot. We were able to correct the patient’s equinovarus position with an Achilles tendon lengthening and external fixation. We believe this aggressive stabili Read More.