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Amputation Prevention / Limb Salvation

SAVE A LEG. SAVE A LIFE.

Every day 230 Americans with diabetes will suffer an amputation.

Read more in the American Journal of Managed Care

Mortality following amputation ranges from 13 to 40% in 1 year, 35–65% in 3 years, and 39–80% in 5 years, being worse than most malignancies. Therefore, amputation-free survival is important in assessing the management of diabetic foot problems.

Read more from The National Center for Biotechnology Information

The Amputation Prevention Center

 

At CACVI, we pride ourselves on our work as an amputation prevention center. We are board-certified consultants in endovascular interventions, specializing in micro-vessel interventions below the knee to preserve the limb with improved blood flow for better and quicker wound healing. We dedicate our practice to saving limbs. Amputation itself has a high mortality rate. It is our mission to prevent amputations. We have saved thousands of limbs and are committed to improving the quality of your life and the lives of those you love.

Our specialized treatment options are designed to address the unique challenges faced by individuals at risk of limb amputation due to vascular diseases. Our approach integrates the latest advancements in endovascular therapy with a personalized care plan tailored to each patient’s condition. 

Surgical Amputation Techniques

Surgical Amputation Techniques

Surgical amputation techniques vary based on the level of amputation, the reason for amputation, and the patient’s overall health and rehabilitation potential. The goal is not only to remove diseased tissue or non-viable limb parts but also to preserve as much function and length as possible, facilitating the use of prosthetics and rehabilitation. Here are some of the more specific surgical amputation techniques:

  • Closed Amputation: This method involves suturing the skin over the amputation site immediately after the procedure, allowing for quicker healing and early prosthetic fitting.
  • Open Amputation: Used in cases of infection, this method leaves the wound open to allow for drainage and cleaning before it is closed in a subsequent surgery.

Types of Amputations

Transmetatarsal Amputation (TMA) – This technique involves the removal of part of the foot but keeps the heel intact, allowing for better end-bearing capabilities. It’s often used for forefoot infections or gangrene and aims to preserve foot length and function while removing diseased tissue.

Below-Knee Amputation (BKA) – Also known as a transtibial amputation, this procedure involves removing the lower leg while preserving the knee joint. It’s one of the most common amputation levels, allowing for good prosthetic outcomes and mobility for the patient.

Above-Knee Amputation (AKA) – Known as transfemoral amputation, this procedure removes the leg above the knee. It requires more energy for the patient to walk with a prosthetic compared to BKA but can be necessary due to extensive disease or injury in the lower leg.

Syme’s Amputation – This is an ankle disarticulation procedure that preserves the heel pad, providing a weight-bearing stump without the need for a prosthetic foot. It’s a good option for patients who may not tolerate or use a prosthetic limb well.

Ray Amputation – In this procedure, one of the toes and a portion of the corresponding metatarsal bone are removed. This technique is often used for localized infection or gangrene and helps preserve the functionality of the remaining foot..

Hip Disarticulation and Hemipelvectomy – Hip disarticulation removes the leg at the hip joint, while hemipelvectomy removes part of the pelvis along with the leg. These are major surgeries typically reserved for extensive disease or injury.

 

    Amputated Leg

    More About Amputation

    Amputation is a surgical procedure that involves the removal of a limb. It often happens as a worst-case scenario to alleviate a painful condition that cannot be managed with other treatments. It only happens when the limb cannot be treated or healed, and would be a great risk to the patient’s health if left untreated. 

    The primary conditions that may lead to amputation include diabetes, peripheral artery disease (PAD), infections, and severe injuries. Among these, diabetes and PAD are the most significant contributors, often leading to poor circulation, nerve damage (neuropathy), and an increased risk of wounds and infections that do not heal properly.

    Peripheral Artery Disease (PAD) – PAD is caused by atherosclerosis, leading to reduced blood flow to the limbs. When severe, it can cause critical limb ischemia, resulting in tissue death, non-healing ulcers, and severe pain, potentially necessitating amputation.

    Diabetes – Diabetes can lead to diabetic neuropathy and peripheral artery disease, significantly increasing the risk of foot ulcers and infections. If these conditions become severe and are not responsive to treatment, amputation might be necessary to prevent the spread of infection.

    Severe Infections – Infections that rapidly spread and cause extensive tissue damage may require amputation if they do not respond to antibiotics or surgical removal of infected tissue. This can include necrotizing fasciitis or gangrene.

    Severe Trauma – Significant injuries from accidents can cause irreparable damage to the leg, making it impossible to save the limb. In such cases, amputation may be performed to remove the damaged portion and preserve the patient’s life.

    Cancer – Bone or soft tissue cancers (such as osteosarcoma or sarcoma) in the leg can sometimes necessitate amputation, especially if the tumor is large or not responsive to other treatments like chemotherapy or radiation.

    Frostbite – Severe frostbite can lead to the death of tissue (necrosis), which may necessitate amputation if the damaged tissue is extensive and poses a risk for infection or affects limb viability.

    Circulatory Disorders – Conditions that significantly impair blood circulation, leading to tissue death, may require amputation. These include Buerger’s disease and Raynaud’s phenomenon which lead to severe outcomes.

    Congenital Limb Deficiencies – In some rare instances, congenital conditions may lead to the need for amputation or surgical modification of limbs to improve mobility or function, although this is typically considered and performed differently than amputations due to disease or injury.

     

      Prosthetic Fitting and Training

      Choosing the right prosthetic limb is critical for enhancing mobility and independence. Prosthetists work with patients to find the best fit, and training is provided to use the prosthetic effectively, including adjusting to different terrains and activities. Advancements in prosthetic technology, such as microprocessor-controlled joints and myoelectric prostheses, offer improved functionality and natural movement patterns, significantly enhancing the quality of life for amputees.

      Regular follow-ups are essential to monitor the healing process, manage any complications, and adjust the treatment plan as needed. Ongoing care with a multidisciplinary team ensures that patients receive comprehensive support throughout their journey.

       

      Angioplasty

      Key Strategies for Amputation Prevention

      Amputation can be prevented. However, it takes a lot of conscious effort and dedication from a patient to ensure that their health situation doesn’t get to the point of amputation. 

      For diabetic patients, they must put effort into maintaining blood glucose within the recommended range. They must also be consistent with their medication, diet, and lifestyle changes. All these can help reduce the risk of complications that may lead to amputation. 

      Routine medical checkups are also necessary for the detection and management of conditions that could lead to amputation. It is important to maintain a close relationship and open communication with your healthcare provider. 

      Daily foot inspections are also necessary as they can catch minor issues before they escalate into serious problems. This includes checking for cuts, blisters, and changes in color or temperature.

      Keep in mind that you must also make some lifestyle changes like smoking cessation, exercising, and maintaining a healthy lifestyle. All these come together to reduce the risk factors for conditions like PAD that may lead to amputation. 

      The Role of Healthcare Providers

      Healthcare providers play a critical role in amputation prevention. This includes providing patient education, conducting regular screenings for at-risk individuals, and managing any foot or leg problems promptly and aggressively. 

      You need to have a healthcare provider like CACVI that has an expert and versatile team. Our experienced specialists can offer comprehensive care tailored to each patient’s needs. Reach out to us now!

        Learn more about the vascular conditions we treat to prevent amputation.

        Arterial Leg Ulcers

        Arterial leg ulcers, also known as Ischemic ulcers or Ischemic wounds, are mostly located on the lateral surface of the ankle or the distal digits. They are commonly caused by peripheral artery disease (PAD).

        The symptoms of arterial leg ulcers include:

        • Painful ulcers, often located on the feet and toes.
        • The skin around the ulcer may be pale, shiny, tight, and hairless due to poor blood flow.
        • In severe cases, the skin might turn black or blue, indicating tissue necrosis.

        Venous Insufficiency Leg Ulcers

        Venous Insufficiency Leg Ulcers are wounds that are thought to occur due to improper functioning of venous valves, usually of the legs (hence leg ulcers). They are the major occurrence of chronic wounds, occurring in 70% to 90% of leg ulcer cases.

        Symptoms of venous insufficiency leg ulcers include:

        • Swelling in the legs or ankles, especially after prolonged standing.
        • Open sores, usually on the inner part of the ankle, that are slow to heal.
        • Itchy or painful ulcers.
        • Leakage of fluid from the ulcer site.

        Varicose Veins

        Varicose Veins are enlarged, swollen, and twisting veins, often appearing blue or dark purple. This condition can be caused by factors like aging, pregnancy, obesity, etc.

        You may have varicose veins if you notice veins in your feet or legs that:

        • Are dark purple or blue in color
        • Are twisted or bulgy
        • Feel heavy or painful
        • Burn, throb, or cause muscle cramping or swelling
        • Harden or change color, which can indicate a more severe condition

        Chronic Venous Insufficiency (CVI) / Venous Reflux Disease

        Chronic venous insufficiency (CVI) is a medical condition in which blood pools in the veins, straining the walls of the vein. The most common cause of CVI is superficial venous reflux which is a treatable condition. Signs may include varicose veins.

        Critical Limb Ischemia (CLI)

        Critical Limb Ischemia (CLI) is a serious condition in which there is inadequate blood flow and oxygen to a specific part of the body. Ischemia is serious form of Peripheral Artery Disease that can cause tissue damage gangrene, ulcers & limb loss.

        Peripheral Artery Disease (PAD)

        Peripheral artery disease (PAD) is a narrowing of the arteries other than those that supply the heart or the brain. Peripheral artery disease most commonly affects the legs, but other arteries may also be involved.

        May-Thurner Syndrome (MTS)

        May-Thurner syndrome (MTS), also known as Iliac Vein Compression Syndrome, is caused when the left iliac vein is compressed up against the spine by the right iliac artery, which increases the risk of deep vein thrombosis (DVT) in the left extremity.

         

         

        Schedule a personalized assessment and find out your treatment options.

        Dr. Moinakhtar Lala and Dr. Mehran J. Khorsandi of CACVI

        Dr. M Lala, Dr. Mehran J. Khorsandi and Dr. V Lala

        Meet Your Specialists


        The Center for Advanced Cardiac and Vascular Interventions (CACVI) is led by Dr. M Lala, Dr. Khorsandi and Dr. V Lala, who have over thirty years of practice with over 15,000 successful vascular and cardiac procedures performed. Our physicians are determined to provide each patient with unparalleled expertise and compassionate care as they work diligently to improve your health.

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