UCSF Barbara Ries

Limb Preservation: The Latest Procedures That Help Prevent Amputation

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Part of our mission at the Amputee Coalition is the vigorous promotion of limb loss prevention strategies. We do this through education and advocacy for better safety measures at home and in the workplace. We also advocate for the advancement of limb-sparing procedures.

Dramatic medical treatments have been developed over the past twenty years that can now salvage damaged limbs that once would have necessitated amputation. Many patients with diabetic neuropathy, cancer or who have been in a violent accident are undergoing pioneering procedures to reconstruct and heal limbs with tremendous success.

Though not applicable in every case that a limb might require amputation, these techniques are changing the medical landscape. The outcomes of these procedures are getting better, with fewer risks, and are saving limbs that not too long ago would not have been salvageable.

This article looks at the financial case for limb preservation, and some of the cutting edge treatments for limbs affected by disease or injury.

Cases in Which a Limb Might Be Preserved

Medical Conditions

There are many conditions affecting limbs that traditionally would have necessitated amputation. Current advanced medical procedures and surgeries have allowed for the successful recovery of limbs affected by:

  • Diabetic Neuropathy
  • Bone Cancer or Malignant Tumors
  • Limb Sarcoma
  • Advanced Peripheral Arterial Disease
  • Acute and Chronic Infections

The treatments for each condition may differ, but the preservation techniques for each overlap.

Traumatic Injury

Limbs that have undergone severe trauma now have a better chance of being saved. A patient can be a candidate for limb salvage surgery if the state of the skin, muscle, nerve, blood vessels and bone allow for one of the procedures detailed below.

The Financial Case For More Limb Preservation Procedures

Much of the world, and indeed much of the United States, does not have access to the advanced surgeries and facilities that help save a patient’s limbs. Successful limb preservation requires access to both pre-op and post-op therapies, and creating more dedicated wound centers for this purpose is costly.

Yet a 2014 study that simulated the 10-year medical cost of a revascularization surgery vs. an amputation found that “the total 10-year costs of revascularization – either endovascular or surgical – were lower than the costs of either local wound care alone or primary amputation. Revascularization strategies also produced more health benefits as measured in terms of years of ambulatory ability, years of limb salvage, or quality-adjusted life-years. In none of the scenarios modeled in deterministic sensitivity analyses did primary amputation prove to be cost-effective.”

Approximately 185,000 people currently undergo amputation each year in the United States. Putting more emphasis on limb preservation facilities may actually reduce the burden on the medical system in the long run.

Limb Preservation Procedures

There are both non-invasive and surgical procedures prescribed for limb preservation, the use of which depend on the wound or condition involved. Surgery will generally be used as a last resort to help save a limb after less invasive procedures are tried.

Hyperbaric Oxygen Therapy

hyperbaric-oxygen-therapy-munson

Photo Credit: Munson Healthcare

This procedure increases oxygen in the blood and may heal or prevent the spread of bone and soft tissue infections, ulcers or gangrene. It is often used in combination with other therapies, and also used in the healing process for other procedures mentioned below.

The patient is placed fully inside a plastic chamber that becomes gradually pressurized with pure oxygen. After approximately two hours the chamber is gradually depressurized. The number of treatments required to heal the limb would vary on the condition and the patient.

Vascular Procedures

Ulcers and wounds due to diabetic neuropathy don’t heal properly due to lack of adequate blood flow. Vascular procedures can be performed to either restore or prevent blood flow and promote healing, and don’t require major surgery.

  • Angioplasty: Opens blood vessels by inflating a small balloon, and inserting a stent to improve blood flow.
  • Embolization: Uses a catheter to deliver blood clotting agents to a specific area, preventing blood flow to malignant growths such as tumors.
  • Thrombolysis: Dissolves blood clots via injection of drugs at the clog site or using a microlaser.

In cases where vascular techniques don’t achieve the required outcome, more invasive surgery may be required.

Surgical Procedures and Reconstruction

Microsurgery

Surgical treatment where a portion of muscle or bone is transplanted from one part of the body to another. Flap reconstruction uses a smaller “flap” of tissue or muscle to perform soft tissue reconstruction. Blood vessels are reattached using intricate surgery to keep the transplanted tissue alive.

Skin Grafts

A skin graft can be used to treat wounds such as diabetic ulcers. Skin is transplanted over the wound and requires no vascular surgery as it begins to grow its own blood vessels

Bone Transplants and Bone Graft Substitutes

Bone transplants can be acquired from compatible donors and used to reconstruct a limb where the bone must be removed. Synthetic bone graft biomaterial substitutes are also starting to be used for bone reconstruction. These synthetic materials are still lacking in reliability and availability, however.

Negative Pressure Wound Therapy

This process created a vacuum that is used to drain excess fluid from a wound. This reduces the risk of infection and increases blood flow to help with healing.

Bone Growing Proteins and Growth Factor Therapy

There is some evidence that the injection or application of proteins such as collagen and keratin at a wound site can improve bone regeneration and increase healing. Studies are still limited as to the efficacy of these treatments.

Learn More About Limb Preservation Treatments

Not all limb salvage procedures will restore perfect function, and patients may still choose amputation if a better biomechanical outcome is projected with prosthetic use. Affordability and accessibility of these pioneering procedures is also currently a barrier for many.

At Amputee Coalition, we are up to date on the current advances in limb preservation. If you or a loved one is currently at risk of having a limb amputated, we encourage you to reach out to us to learn more about your options. Your care team should also be consulted to arrive at the best decision for your individual situation.

Along with providing information about procedures, we can also direct you to potential financial assistance if income is a barrier to treatment.

Photo Credit: Barbara Ries via UCSF Limb Preservation and Diabetic Foot Center.