There are approximately two million people living with limb loss in the U.S. 54% are related to vascular disease (including diabetes and peripheral vascular disease), 45% are trauma related and 1% malignancy related. There are 185,000 amputations per year in the U.S. In 2009, hospital costs associated with amputation totaled more than $8.3 billon. African Americans are 4 times more likely than Caucasians to have an amputation. Nearly half of the individuals who have an amputation due to vascular disease will die within 5 years. This is higher than the five-year mortality rates for breast cancer, colon cancer and prostate cancer.
Limb Salvage traditionally referred to an orthopedic oncology procedure where a patient has a malignant tumor of the extremity. Limb salvage or limb sparing procedures involved removing the tumor while sparing the limb from amputation and preserving tendons and ligaments. This in turn preserved limb function.
In recent years the term limb salvage has been extended to saving limbs in jeopardy of amputation from vascular disease and diabetes. Multi-disciplinary programs have been established reflecting the importance of many different medical specialties in treating these patients. Vascular diseases can be arterial, venous or both. Diabetes is associated with traditional macrovascular disease (peripheral vascular disease) and microvascular (small vessel) disease. Less common are diseases which damage blood vessels (vasculitis).
Studies have shown that limb salvage programs can reduce the risk of amputation up to 75% if a team specializing in the care of diabetic foot ulcers is involved. This team may consist of specialists in wound care, podiatry, infectious disease, endocrinology, nephrology, vascular medicine (cardiology, interventional radiology) and vascular surgery.
At Rapha Wound Care Associates, we believe in the limb salvage approach to leg wounds. We have adopted an evidence-based limb salvage protocol that utilizes the latest scientific evidence, technology and medical specialists when indicated. For wounds that don’t decrease in size by 50% in 4 weeks we can offer skin substitute grafting which utilizes regenerative healing with stem cells (see section on regenerative medicine). In this way, we give patients the best chance for lower extremity wound healing and limb preservation.