Emphasizing The Multidisciplinary Approach To Diabetic Limb Salvage

Melissa Adams, DPM, and John S. Steinberg, DPM

   Obviously, no clear answers exist regarding which providers should be involved in this team approach or the extent of involvement provided by each member. This may be partly due to the fact that various levels of team involvement are required in caring for the needs of each individual patient.

Recognizing The Need For Appropriate Referral

Therefore, the specific needs of the patient and significance of the current medical condition dictate the necessity of each medical discipline and the degree of team involvement. Political bias and professional ego can often block necessary members from working to their full potential in the setting of a limb salvage team. These barriers are present to a lesser and lesser degree but remain in place nonetheless.

   When we obtain a thorough history and perform the physical examination, it is vital to review and question the presence of any existing medial conditions or comorbidities. In addition, one must properly assess neurovascular status, dermatological involvement, musculoskeletal deformities and the presence of infection. After compiling this information, team members can be properly engaged to aid in the realization of limb salvage.

   Depending upon the individual patient’s presentation, the patient’s lower extremity care may be provided solely by the podiatrist or there may be the need for referrals to vascular surgery, orthopedic surgery, plastic surgery, interventional radiology, internal medicine, endocrinology, infectious disease, nephrology and/or neurology. Beyond the physicians, it is vital to consider the involvement of a nutritionist, physical therapist, pedorthotist, prosthetist, nurse practitioner, wound care nurse, home health and/or certified diabetic educator in the team approach to diabetic limb salvage.

In Conclusion

Evaluation on an individual basis with quick recognition of the need for adjustment or assistance in the course of treatment is imperative to caring for these patients. Communication is crucial to the effectiveness and survival of this multidisciplinary team approach. Providers from the aforementioned disciplines may already be involved in the care of your patient but are all of you communicating as a team?

   Each team member must recognize the individual patient’s goal and convey the requirements needed to meet that goal in relation to each medical discipline. It is vital to strive for clear communication between each discipline. In addition, physicians must properly inform the patient and his or her family, and ensure a clear understanding of the treatment plan as a whole.

   Dr. Adams is a third-year resident of the INOVA Fairfax Podiatric Residency Program in Falls Church, Va.

   Dr. Steinberg is an Assistant Professor in the Department of Plastic Surgery at the Georgetown University School of Medicine in Washington, D.C. Dr. Steinberg is a Fellow of the American College of Foot and Ankle Surgeons.

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