April is limb loss awareness month. More than 180,000 people will have an amputation this year. That means more than 500 people per day will undergo an amputation. Vascular surgeons, wound care specialists, plastic surgeons, podiatrists, and primary care physicians all provide valuable services to the wound care team to prevent limb loss. However, there are steps patients can take to decrease their chances of limb loss.
Who is at risk for limb loss?
Diabetic patients are at an increased risk of limb loss. This is for several reasons. To start with, diabetic patients tend to have elevated glucose levels. This can lead to bacterial infections more easily and prevent the body’s immune system from working appropriately. In addition, the neuropathy associated with diabetes means that patients have a difficult time feeling when they have a cut or wound on their feet. This can lead to a delay in treatment until the wound has significantly worsened. For this reason, diabetic patients and those with neuropathy should check their feet daily.
Vascular disease is a major underlying diagnosis for patients who require limb loss. More than 50% of all patients who require an amputation have vascular disease. Some patients require an amputation due to a traumatic injury and very few require an amputation due to cancer. However, vascular disease remains the most easily modifiable factor. Patients who have peripheral vascular disease, also known as PAD, can have calf pain when they walk. Some also have pain at rest.
Patients with peripheral arterial disease should see their primary care physician and vascular surgeon on a regular basis. Patients should take their medications as prescribed. Blood pressure medications, heart medications, cholesterol medications, and diabetes medications can make a big different in the development of peripheral arterial disease over time.
What are contributing factors to limb loss?
Smoking remains a key risk factor in peripheral arterial disease and limb loss. Patients should not smoke or use tobacco products of any kind. Even electronic cigarettes or “vaping” can contribute to peripheral arterial disease and are not safe. Patients should ask their physicians for medications to help quite tobacco use if needed. Even patients who have smoked for many years will benefit from quitting as soon as possible.
Most patients will have a foot cut or ulceration prior to needing an amputation. Initial ulcerations are treated with wound care and often require a vascular surgeon to optimize blood flow. This can be done with a bypass or using a minimally invasive techniques with wires, catheters, and stents. Your vascular surgeon will help you decide on the best treatment.
Patients can develop ulcerations on their feet for a variety of reasons. Some patients will develop cuts on their feet due to minor injuries like a fall within the house. Other patients can develop ulcers due to sitting or lying in one place for a long period of time. This can occur after a medical procedure or if patients are unable to walk. Some patients with severe venous problems can also develop ulcerations. These are best treated with wound care and occasionally vein treatments. Of course arterial disease can be so severe ulcerations develop as well.
Ulcers can also become infected. The infection needs to be treated with antibiotics or surgery to remove the infected tissue. Patients need to see their physicians and wound care team as scheduled to ensure the infection isn’t spreading or worsening. Patients can become extremely sick or even die from severe infections. These patients can require hospital admission and treatment in the intensive care unit. Sometimes the infection is so severe that patients require an amputation to prevent death.
Some patients have such severe peripheral arterial disease that medication and surgical intervention are unable to improve blood flow. These patients are sometimes treated with wound care and pain medication. Unfortunately, these patients are at an increased risk of limb loss and ultimately, due to pain or infection, may require an amputation.
How do you prevent limb loss?
In summary, patients can prevent amputations by taking care of themselves. They should see their physicians as scheduled. They should do daily foot checks or wound evaluations if they have diabetes or neuropathy. Patients with diabetes should prevent elevated glucose levels and treat them aggressively if needed. Patients should take all of their medications as instructed to help prevent and treat peripheral vascular disease. They should follow their wound care instructions if they have a wound and seek wound care early. Finally, and most importantly, patients should not use tobacco products of any kind.