Salvaging Limbs: Teamwork between Podiatrists, Vascular Surgeons Breeds Success

July 21, 2017

*Online Exclusive*

Track 1: Limb Preservation
Thursday, July 27
2:30–4 p.m.
Tennessee C

Saving the foot of a person with non-healing wounds requires more than surface wound treatment when poor circulation is a barrier. In those circumstances, podiatrists need to team up with vascular surgeons and other health-care professionals in a limb salvage program. During a Limb Preservation track presentation Thursday, a vascular surgeon will discuss the roles of team members.

“When we have an active limb salvage program with the podiatric community, I am the circulatory side and the podiatrist deals with the biomechanical and the foot surgery side,” said Christopher J. LeSar, MD, a vascular surgeon who will present “Critical Limb Ischemia.”

“Another component that is critical for a limb salvage program is infection control. The last piece is metabolic control. We have to control all of those things to make sure the patient heals properly,” said Dr. LeSar, a critical limb specialist at the Vascular Institute of Chattanooga, TN.

Dr. LeSar will explain the angiosome concept, how the circulatory system functions, and options for treating artery obstructions in lower extremities.

“I will be discussing the physiology behind limb salvage and what I need to do from a vascular standpoint to improve the circulation to a point where the podiatrist can functionally heal the wound,” he said. “Bypass surgery still has its place, but it is further down the chain from the first thing we do.

“Many times we do an endovascular-first approach. With that concept, we treat the blockages within the arteries, which gives us a much broader ability to tackle specific problems directly. We try to repair arteries in a timely manner to get the circulation back. Doctors say time is tissue when it comes to ischemia, because progression of disease can be very rapid over a 24-hour period.”

The collaboration required in a limb salvage program can occur in both inpatient and outpatient environments. Research shows that such programs drive improved patient outcomes and reduced costs, readmissions, and lengths of stays in the hospital, Dr. LeSar said

“Currently, most of the procedures take place in an outpatient environment,” he said. “We can do high-level limb salvage care in an outpatient environment and have been doing that for a number of years with very good limb salvage rates.”

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