Midterm Outcomes of Neuroischemic and Ischemic Wounds Treated by a Multidisciplinary Limb Salvage Service

Abstract

Multidisciplinary limb salvage teams have been shown to decrease the frequency of major amputations by increasing the rate of revascularization procedures and minor amputations. The outcomes of wound healing, recurrence and ambulatory status in multidisciplinary amputation prevention clinics are assumed to be improved but are not routinely reported. This study investigates the midterm outcomes of ischemic and neuroischemic wounds treated at our multidisciplinary limb salvage clinic. A retrospective review of patients treated at a single institution multi-disciplinary limb salvage clinic over 12 consecutive months. Only patients with ischemic or neuroischemic wounds were included in the analysis. Patient demographics, wound characteristics, procedural details, clinical outcomes and ambulatory status were reviewed. Clinical endpoints under study included time to wound healing, reulceration rate and ambulatory status. Over the study period there were 141 new patients and 901 clinic visits. 80 patients were treated for neuroischemic or ischemic wounds. In 64% of patients (51/80) wounds were present for >6 weeks before referral. Previous vascular surgical history was present in 34% (27/80) and 23% (18/80) had a previous minor amputation. 40% of wounds (32/80) were limited to the toes or the forefoot whereas 21% (18/80) involved the rearfoot or ankle. A total of 62 vascular interventions were performed with an equal distribution of endovascular and open revascularizations. 56% of wounds (45/80) were fully healed over the observation period. The average time to fully healed was 16 weeks. Rearfoot or ankle wounds were predictive of failure to heal (OR, 0.32; 95% CI, 0.10-0.99; P < .05). 16% of patients (13/80) developed a new wound on the ipsilateral leg during follow up. On initial evaluation 56% (45/80) of patients were fully ambulatory without assistance. After treatment, 13% of patients (10/80) had a net deterioration in their ambulatory status. Multidisciplinary limb salvage teams effectively heal wounds and maintain ambulatory status in patients with ischemic and neuroischemic wounds. Patient specific factors, such as rearfoot or ankle wounds, can adversely effect on the outcome. Even with high quality care, 16% of patients can be expected to have a recurrence.