Are There Other Options Besides Amputation

For patients with Peripheral Artery Disease, appropriate wound care can be the difference between amputation and limb salvage.

Why is wound care so important if you have Peripheral Artery Disease?

The reason wound care is so important is that when you have Peripheral Artery Disease (PAD), you are not getting enough blood flow to the extremities. When that happens, you are predisposed to developing a breakdown of the skin or a severe infection of the skin, which can progress to infection of the bone, eventually leading to amputation in some cases. To prevent these things from happening, local wound care is vital for patients with PAD. One of the highest risks is in cutting their toenails because a small cut to the surrounding skin can develop a severe infection. For this reason, many patients with PAD see a podiatrist for toenail maintenance.

What are the risk factors of non-healing foot wounds?

There are quite a few risk factors for poor healing of a wound, particularly in the feet. The most prominent is diabetes mellitus for a number of reasons. Diabetes is a risk factor because of the disease itself, and because it causes peripheral neuropathy, or numbness of the toes. Because there is no feeling in the toes, it’s possible to sustain trauma to the foot without knowing it. Also, diabetic patients are more prone to infections, making diabetes the number one factor that leads to non-healing wounds in the foot.

Other factors for non-healing wounds include arterial disease because there is a lack of blood flow to the foot and to the toes and venous disease. Patients with vein problems have clots in the veins or leaky veins and get swelling in the legs, which is an important risk factor. This can be seen in patients with skin changes, scaling or hyperpigmentation, and eventually breakdown or ulceration of the skin. These changes are caused by the increase in venous pressure in the ankle and foot region. Other risk factors are metabolic causes, a patient has an underlying problem with their cancer, or malnutrition. Also, when the patient has neurological problems, particularly where the foot is a little bit deformed and they are pounding on that one spot all the time, they can develop pressure ulceration in that spot and without an offloading in that area there will be poor healing.

What is the difference between revascularization and amputation?

Revascularization means increasing the blood flow of the blood vessels into the leg and foot, either by stenting or surgery. We are trying to bring blood flow to a place where there wasn’t blood flow before to prevent an amputation. When you don’t have enough blood flow to an area like in the foot, initially, you may just develop some pain with exercise. At the next stage, you may develop pain at rest, and then eventually, you may develop ulceration which doesn’t heal or turns into gangrene. So, when nothing else can be done, you amputate that segment. But the whole point of revascularization is to prevent amputation.

Does a non-healing wound mean you will eventually require an amputation?

If you have a non-healing wound, it is likely that it will eventually develop frequent infections in that region, and the infection may spread into the bone adjacent to that area. Then, if that infection cannot be controlled, and it spreads, you may eventually require an amputation to save your life.

Request an Appointment with Dr. Shams at your nearest American Endovascular center today.