Saturday, May 21, 2022

Searching for case studies, information for limb salvage versus amputation (for chronic wound)


Dear fellow O&Ps,

Here’s a little snap shot of this gents situation:
This 69 year old man refused to have amputation left below knee last
week for large deep ulcer with osteomyelitis and destroyed Achilles
tendon (I’ve honestly never seen anything like it in the 10years I’ve
been working). He has type 2 diabetes and right amputated toe. History
of falls, subdural, hypertension, renal impairment and leprosy treated
in 80s. Ulcer has been present for 6/12 and managed by podiatry foot
clinic. He has minimal pain and the ulcer. He lives alone, retired,
looks after himself well and is compliant with medical advice, attends
clinics as requested. He has met and discussed at length option of
amputation, however on all occasions did not engage initially and the
frank discussion of likely outcome of conservative management did not
have much impact.

Just to clarify, I’ve offered him to meet and speak with an amputee, but
he has refused. I cottoned on that he was of an academic mind, so I’ve
offered to provide him with some evidence about outcomes of limb salvage
versus amputation for a diabetic, chronic wound, which he has agreed
to… but this is my problem… I’m struggling to find anything! I’m
trying to avoid the information that suggests amputation as a failure,
which I’m finding in most of the published information from the vascular
and podiatric fields.

I am calling on you all to help me try and get my hands on information,
in order for him to make an informed decision about a potential elective
amputation, however I’m finding it difficult to find written evidence
out there that supports amputation for quality of life, long term
functional outcomes of amputation versus living with a chronic,
non-weight bearing foot.

So, if you have any written information that you wouldn’t mind sending
me… or know of any good, sound case studies or published articles,
please forward them to me.

Thank you all for your time.

Monique Van den Boom
Austin Health
ph: 03 9490 7666

Austin Health – 2012 Metropolitan Health Service of the Year


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