Avoiding lower extremity amputation
Bardia Anvar, M.D.
Given the prevalence of diabetes in the United States, the fact that the disease is the number one cause of lower extremity amputation is an extremely serious matter. Worldwide, a lower limb is lost to diabetes every 30 seconds and in the U.S. alone, some 2 million Americans are living with a lost lower limb.
According to the World Health Organization, lower-extremity amputations are 10 times more common in people with diabetes than in those who don't have the disease and represent half of all amputations in the U.S. In addition to being physically and emotionally devastating to patients, diabetes-related amputations cost our healthcare system some $3 billion dollars per year ($38,077 per amputation).
It is also important to consider that lower extremity amputation does not represent a traditional medical complication of diabetes like myocardial infarction, kidney failure or retinopathy. Instead, they often result from foot ulcers, a particularly serious matter given that 25% of diabetics will develop these sores.
Since most of such lower limb amputations are performed on older adults, staffs of assisted living facilities and nursing homes must be especially vigilant in monitoring their charges – especially those with diabetes. Since these facilities are subject to heavy federal fines if negligence or improper/inadequate care is determined, it is important that preventive measures be taken. Should a foot ulcer develop, patients must be cared for immediately.
To avoid long and costly hospital stays (average is 10 days), many assisted living facilities and nursing homes are outsourcing wound prevention and treatment to outside companies that provide services conveniently right at the facility.
Here are tips on how to avoid lower extremity amputation for your residents:
- Adequate glycemic control, periodic foot inspection and patient and family education are key preventive steps
- In patients with plantar diabetic foot ulcers, off-load by using a total contact cast or irremovable fixed-ankle walking boot
- In patients with a new diabetic foot ulcer, conduct a probe-to-bone test followed by an MRI if a soft-tissue abscess or osteomyelitis is still suspected following the test
- Sharp débridement of all devitalized tissue and surrounding callus material from diabetic foot ulcerations at 1- to 4-week intervals
- For ulcers that don't improve by more than 50% after 4 weeks of standard wound therapy, adjunctive options are advised (i.e., negative pressure therapy, various biologics, hyperbaric oxygen therapy, etc.)
Bardia Anvar, M.D., is the medical director of Skilled Wound Care.