When Limb Salvage Becomes Heartbreaking
by Aletha Tippett MD
What? How can limb salvage be heartbreaking? Isn't it great to save a leg and a life? Of course, that is all wonderful and is what keeps you going in this very difficult field. What is heartbreaking is when you have worked so hard and are winning the game, only to have your patient swooped away by others and the limb is amputated without ever being contacted or consulted.
The Loss of a Limb Salvage Patient
Over the past decade this has happened to me several times, but recently it happened again. We had been caring for an elderly patient with diabetes who was on renal dialysis and who had a number of wounds on her foot. She had a heel eschar, a large plantar surgical wound, and two or three other small abrasion-type wounds. We have been treating her every two weeks for several months, including maggot therapy which she wanted, and had seen excellent results with her wounds. All wounds were healing very well and were not long from closing. We were on the phone the other day sharing lab information with the patient's dialysis unit and they said, “well, if she comes back.” We said, “what do you mean?” They said the last they heard she was at a major university hospital with plans to amputate her leg. We were sick at heart to hear this. We won't know the outcome for some time. It almost makes you want to give up—why can't there be communication between facilities and physicians?
Cornerstones of Amputation Prevention: Communication and Education
Lack of communication is a problem in health care in general, and for limb salvage in particular. There was one case, however, where communication was there and I spoke personally to the physician, begging him not to amputate my patient because it could kill him. The next day he proceeded with the amputation and by that evening my patient was dead. More heartbreak.
So, in the field of limb salvage, some glaring difficulties are lack of communication and differing opinions on the value of limb salvage. I will not stop limb salvage efforts, but there needs to be continued education on the importance and value of limb salvage. It also reminds me how very vulnerable these patients are and how deserving they are of the best care they can receive.
About The Author
Aletha Tippett MD is a family medicine and wound care expert, founder and president of the Hope of Healing Foundation®, family physician, and international speaker on wound care.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.