Diabetes is a major factor in more than half of all non-traumatic lower limb amputations performed in America today. Because diabetes damages both nerve and circulatory function, your ability to recognize and heal from injury is significantly impaired. This can cause a chain reaction, where minor cuts and scrapes can spiral out of control. They turn into larger wounds, the wounds get infected, and once the infection spreads too far, surgery is the only viable solution.
However, improving surgical techniques have provided a potential way forward other than a preventative amputation—limb salvage surgery. In a limb salvage procedure, the goal is to preserve a functional limb to the greatest extent possible, while reducing the risk of future ulceration and infection.
Why Consider Limb Salvage?
Amputations, especially those that remove all or most of a foot, can have devastating consequences. The most obvious of these is loss of mobility and independence—you can no longer walk, move, or enjoy activities as you once did. But that’s not the only bad news. Five-year mortality rates for people with a significant amputation are shockingly poor—worse than even certain cancers, include breast and prostate cancer.
By contrast, a limb salvage procedure can (in some circumstances) provide much improved long-term quality of life. By applying a variety of advanced surgical techniques, it may be possible to save the limb, or at least enough of the foot that it can continue to provide stable biomechanical function. Patients who are good candidates for a limb salvage and undergo the procedure typically have significantly better long-term outcomes than those in similar circumstances who undergo primary amputation.
Some of the techniques that may be employed include:
- Debridement of infected and/or dead tissue and bone
- Incision and drainage of an abscess
- Advanced wound closure techniques
- Bone and skin grafts or transplants
- Synthetic implants
- Reconstructive surgery
- Vascular and nerve treatments
Is Diabetic Limb Salvage Right for Me?
While limb salvage procedures can offer many benefits, they are not for everyone. Depending on the degree of damage, biomechanical function with a successfully salvaged limb may still be limited. There is a risk that future surgeries or hospitalizations may be required for a number of reasons, including tissue rejections or the return of infection. Post-surgical recovery and rehabilitation can be slow and difficult for many patients, too.
Your surgeon will help you define a realistic expectation for your limb salvage surgery, including the best-case, worst-case, and average outcome for a patient in your circumstances. For many patients, the potential benefits of a successful limb salvage make it the clearly superior choice. For others, an early amputation and fitting for prosthesis may be a safer, faster option with a better expected long-term outcome. Each case is different, and there isn’t always a clear-cut right-and-wrong answer. Your surgeon will go over the pros and cons of each option in detail, answering all your questions and concerns fully, before the two of you arrive at a decision.
Regardless of the ultimate choice, the most important thing is to address any diabetic foot wounds and complications as quickly as possible. The longer you wait for treatment, the greater the damage to your feet, and the worse off you will be in the long run. To schedule an appointment with one of the podiatric physicians at the Northwest Extremity Specialists, please contact the office nearest to you.