Amputation

Temple University School of Podiatric Medicine's picture
Wound Care Journal Club Review

A major concern in managing patients with diabetes is their susceptibility to acquiring ulcers in their feet. If these patients are not careful, these ulcers may become infected and eventually lead to additional sequelae, ending in lower extremity amputation. The focus of this study was to determine the major factors of lower extremity amputation in the diabetic foot, in hopes that clinicians may be able to reduce the rate of amputations more effectively.

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Aletha Tippett MD's picture
balancing choice with outcomes

by Aletha Tippett MD

How do you know if you are making right choice for a patient? Or, how do you know if you are even making a choice? This is true in the world of limb salvage. I have witnessed too many patients for which the risk of amputation was too much, and they died. But how do you know what the outcome will really be? You never really know, but you can make your best guess.

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Samantha Kuplicki's picture
Wound Care Case Study

This is the account of a patient case in which technology, clinician experience, and patient adherence converged to save a limb.

In August of 2013, a 59 year old female with noninsulin-dependent diabetes mellitus, severe peripheral artery disease, a history of tobacco abuse and a recent right transmetatarsal amputation (TMA) was referred to our hospital-based outpatient department by her home health nurse. Her surgery was one month prior to presentation. During her intake visit with the foot and ankle surgeon, she recounted her post-surgical instructions to include "wash incision once daily with betadine." The home health nurse had referred her back to the surgeon's office with concerns that the surgical incision was not approximating beneath the staples and wound closure strips. At that time, the surgeon removed all closure devices, leaving the wound open. He did not change the patient's care regimen.

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Aletha Tippett MD's picture

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.

Cheryl Carver's picture

by Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA, CLTC

If you could trade places with one person for one day, who would it be? Your first thought may be an Olympian, celebrity, or even a superhero. Who wouldn't want to be awarded a gold medal, walk the red carpet, or wear a cape to soar above the big city? One thing remains certain, not one of us would choose to be one of our wound care patients. There is definitely nothing appealing about having a chronic wound.

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Lindsay Andronaco's picture
Blood Pressure Cuff

by Lindsay D. Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS

Patients who come in with venous insufficiency ulcers and lower extremity arterial disease (LEAD) should be evaluated for compromised vascular status and the use of compression. The purpose of the ankle-brachial index (ABI) test is to support the diagnosis of vascular disease by providing an objective indicator of arterial perfusion to a lower extremity.

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Mark Hinkes's picture

by Dr. Mark Hinkes, DPM

Twenty first century technology is helping people with diabetes to heal foot ulcers. An Australian colleague, for example, is developing an application that reminds people with diabetes to control their blood sugars with prompts and instructions, and allows them to upload a picture of their wound for their podiatrist to evaluate.

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Aletha Tippett MD's picture

by Aletha Tippett MD

In considering this question as to whether amputation can be palliative, let’s keep clear that these are two separate subjects that sometimes interact. It is key to always keep our goals in mind. What is the goal in palliative care? The goals are to provide comfort, relieve pain, prevent infection, and improve or maintain quality of life. These goals are always to be in concert with the desires and wishes of the individual patient.

Lydia Meyers's picture

by Lydia A Meyers RN, MSN, CWCN

Diabetes is the number one cause of amputation for wound care patients. Individuals with diabetes need monitoring and education about the dangers they face on a daily basis due to their condition. Diabetic ulcers often begin with a simple bump, as a callous or by stepping on something.

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Laurie Swezey's picture

by Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS

Diabetic foot ulceration can lead to significant morbidity and mortality and is probably one of the most-feared complications of diabetes. Loss of limb (amputation) is a frequent outcome of diabetic foot ulceration.

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