Minor Amputation and Palliative Wound Care as a Strategy to Avoid Major Amputation in Patients With Foot Infections and Severe Peripheral Arterial Disease

Barshes, Neal R.; Gold, Benjamin D.; Garcia, Aimee; Bechara, Carlos F.; Pisimisis, George; Kougias, Panos

doi:10.1177/1534734614543663

Cited by 26 publications

(13 citation statements)

References 22 publications

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“…Every year, 4 million diabetic patients develop DFUs. Worldwide, one person undergoes DF amputation every 30 sec (21). However, 85% of these amputations could be avoided (21), and it is important to identify reliable and stable molecular markers of DFU in diabetic patients.…”

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confidence: 99%

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Expression of TGF-β1 and miRNA-145 in patients with diabetic foot ulcers

Zhang

Ren

Liu

et al. 2016

Experimental and Therapeutic Medicine

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The aim of the present study was to investigate the expression levels of transforming growth factor (TGF)-β1 and microRNA (miRNA)-145 in patients with diabetic foot ulcers (DFUs). A total of 26 patients with DFUs requiring amputation were enrolled in the study between January 2013 and August 2014. In addition, 15 trauma patients undergoing amputation over the same time period were included as a control group. Samples were collected from the blood, the dorsalis pedis arteries and muscles of the amputated limbs. The expression levels of TGF-β1 mRNA and miRNA-145 in these samples was detected using reverse transcription-quantitative polymerase chain reaction. The expression levels of TGF-β1 protein were evaluated using western blot analysis. In comparison with the control, the protein and mRNA expression levels of TGF-β1 in the DFU patients was significantly higher in the serum and the dorsalis pedis arteries, and significantly lower in the muscles with ulcers. In contrast, the expression levels of miRNA-145 was significantly lower in the blood and the dorsalis pedis arteries, and significantly higher in the muscles with ulcers in DFU patients compared with the control. The results of the present study suggested that there exists an inverse correlation between the expression levels of miRNA-145 and TGF-β1 in patients with DFU; thus suggesting that miRNA-145 may regulate the expression of TGF-β1 in patients with DFUs.

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confidence: 99%

“…Worldwide, one person undergoes DF amputation every 30 sec (21). However, 85% of these amputations could be avoided (21), and it is important to identify reliable and stable molecular markers of DFU in diabetic patients. In the present study, it was found that the expression of miRNA-145 is negatively correlated with TGF-β1 expression.…”

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confidence: 99%

Expression of TGF-β1 and miRNA-145 in patients with diabetic foot ulcers

Zhang

Ren

Liu

et al. 2016

Experimental and Therapeutic Medicine

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“…9,10 Strikingly, among those with severe PAD who receive a major (ie, above-ankle) amputation, up to 75% are no longer able to ambulate and 50% can no longer live independently. 11 Therefore, limb preservation efforts in the setting of soft-tissue defects must aim to control and prevent infection, improve arterial flow, and restore an intact skin barrier. 12…”

Section: Discussionmentioning

confidence: 99%

“…13 Additionally, studies have identified wound palliation, defined as wound care without the expectation of complete healing, as a potentially safe alternative to major amputation in this setting. 11,14…”

Section: Discussionmentioning

confidence: 99%

Long-Term Wound Palliation to Manage Exposed Hardware in the Setting of Peripheral Arterial Disease

Zamani

Barshes

2019

Plastic and Reconstructive Surgery - Global Open

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Summary:Exposed orthopedic hardware in the lower extremity complicated by peripheral arterial disease typically demands multiple operative procedures by several disciplines to maintain skeletal integrity and achieve complete wound healing. For ambulatory patients that are either not candidates for lower extremity revascularization or prefer not to pursue surgical attempts at limb preservation, wound palliation is a potential management strategy. We discuss a patient with a history of severe peripheral arterial disease and a left pilon fracture previously treated with open reduction and internal fixation. He presented with a 2-month history of open wounds and exposed hardware over his left tibia. Though he initially underwent surgical revascularization to improve circulation to his lower extremity, the arterial bypass occluded within 6 months of the operation. At that point, the patient decided to forego any additional surgical intervention, including hardware removal, in favor of local wound care and expectant management. Remarkably, the wound remained stable in size over the next 14 years, he remained ambulatory, and never developed a deep wound infection. Though palliative wound care alone is understandably not the recommended first-line therapy for managing nonhealing wounds, it may be a safe and potentially durable alternative to major lower extremity amputation when revascularization and soft-tissue coverage cannot be achieved.

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“…Major amputation is often undertaken when peripheral arterial disease and when moderate to severe infection is present, and revascularisation would likely place the individual at risk with little gain. A small study compared minor amputation and palliative wound care ( n = 11 people and 13 limbs) and aged‐matched controls who had major surgery ( n = 12 people and 13 major amputations) average age 80 years showed 1 to 2‐year survival rates were similar, and reoperation was uncommon in both groups .…”

Section: Benefits Of Palliative Wound Carementioning

confidence: 99%

Integrating palliative care with usual care of diabetic foot wounds

Dunning

2016

Diabetes Metabolism Res

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Palliative care is a philosophy and a system for deciding care and can be used alone or integrated with usual chronic disease care. Palliative care encompasses end-of-life care. Palliative care aims to enhance quality of life, optimize function and manage symptoms including early in the course of chronic diseases. The purposes of this article are to outline palliative care and discuss how it can be integrated with usual care of diabetic foot wounds. Many people with diabetes who have foot wounds also have other comorbidities and diabetes complications such as cardiovascular and renal disease and depression, which affect medicine and other treatment choices, functional status, surgical risk and quality of life. Two broad of diabetic foot disease exist: those likely to heal but who could still benefit from integrated palliative care such as managing pain and those where healing is unlikely where palliation can be the primary focus. People with diabetes can die suddenly, although the life course is usually long with periods of stable and unstable disease. Many health professionals are reluctant to discuss palliative care or suggest people to document their end-of-life care preferences. If such preferences are not documented, the person might not achieve their desired death or place of death and health professionals and families can be confronted with difficult decisions. Palliative care can be integrated with usual foot care and is associated with improved function, better quality of life and greater patient and family satisfaction.

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Minor Amputation and Palliative Wound Care as a Strategy to Avoid Major Amputation in Patients With Foot Infections and Severe Peripheral Arterial Disease

Cited by 26 publications

References 22 publications

Expression of TGF-β1 and miRNA-145 in patients with diabetic foot ulcers

Expression of TGF-β1 and miRNA-145 in patients with diabetic foot ulcers

Long-Term Wound Palliation to Manage Exposed Hardware in the Setting of Peripheral Arterial Disease

Integrating palliative care with usual care of diabetic foot wounds

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