Chronic and complex wounds of the lower extremity frequently recur. It is difficult to determine the precise recurrence rate across patients with different lower extremity wound types, including diabetic foot ulcers, arterial ulcers, pressure injuries, and venous ulcers. However, we know that...
By Aletha Tippett MD
For part 1 in this series, click here.
In a previous blog I told about the heartbreak of limb salvage when one of your patients was swooped out of your care and had an amputation. The patient I mentioned did have an amputation—a guillotine amputation just above the ankle. She stated she had become very sick and her foot was infected. Now what happens with this patient?
When we first saw her after her amputation the stump wound was 9x7cm with minimal granulation, some white slough and a crusted wound border. In addition there was a pressure ulcer 3.6x3cm with about 50% slough, no granulation, on her posterior lower leg due to her leg resting on the bed. The patient had pain in her stump.
Assessing the Patient and the Wounds
So several things were immediately evident following my assessment. The patient needed protection of her lower leg to prevent development of pressure ulcers, so she was fitted with an air boot. Both of patient’s wounds needed aggressive care, so both were dressed with a medicated hydrogel, WoundPal®. Once the medicated hydrogel was in place, the patient had no further pain in her stump, so pain control was not a problem.
After two weeks of treatment, both wounds were significantly decreased in size, 7x6cm (33% reduction) for the stump and 1.5x2cm (>70% reduction) for the pressure ulcer. Both had beefy granulation with no slough. Wound edges were contracting in both wounds.
The wounds appear to be healing well and the air boot is adequately protecting the stump. It is not too early to start thinking about a prosthetic for her foot and she was given a referral to a good orthotist who can design something for her.
Treatment Goals After Lower Extremity Amputation
While the primary goal is to avoid amputation and maintain wholeness, sometimes the amputation does happen, maybe to save a life from infection. That is when you recognize the person is more important than their limb. The person is more than just a body part and the person is still the same person after the amputation. Fortunately for this patient the amputation was limited enough she did not have severe cardiovascular impact. The goal now is to maximize comfort and function. I will report again at a later date on status of this patient.
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.