Prevention of Major Amputations in Nonischemic Lower Limb Lesions

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Abstract
Major lower limb amputations continue to be performed at an increasing rate, the major cause being the rising prevalence of adult onset diabetes. It can be demonstrated that a reduction in amputation rate can be achieved at institutes with a higher level of academic and specialty interest, by avoiding errors of management and by newer technical innovations in wound closure. A simpler method of wound closure that is easily taught and learned and is readily available to the medical community and the patient population can play a substantial role in reducing the number of amputations. Satisfactory closure of open lesions by full-thickness skin and subcutaneous tissue carries with it a lower incidence of recurrence, reduces costs by avoiding or reducing length of hospitalization, and minimizes use of general anesthesia, a serious matter in immunocompromised older patients. Avoiding errors of technique will additionally reduce amputation rate. In the last 10 years, 125 patients, mostly diabetic and elderly, with major and recurrent lesions of the lower extremities, have been treated by closure of the debrided wound with a combination of external tissue expansion and wound toilette. Major lower limb amputations have been avoided. Experience confirms that the relationship between high hospital volume, specialty interest, higher level of academic care; avoiding technical errors; and simplifying the methodology, lead to a reduction in need for major amputations. A lower mortality in the patient population at risk is achieved and a reduction in costs, which have risen beyond the 132 billion dollars level, can be expected.