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Surgery
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Surgery
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Clinical Science
Abstract Type
Case Report
Abstract
Background: Limb salvage and prosthetics play vital roles in restoring function and mobility for patients with severe injuries or metabolic conditions. Limb salvage involves surgical techniques aimed at preserving a limb rather than resorting to amputation, while prosthetics provide artificial devices to replace lost limbs. Key considerations for limb salvage include restoring a functional foot, maintaining patient independence, minimizing hospitalizations, and avoiding bilateral lower limb amputations.
Case Presentation: The patient, already at single-limb status, presented with a necrotic heel ulcer, exposed calcaneus, and necrotic Achilles tendon. After vascular optimization, the risks and benefits of final aggressive measures were discussed, leading to consent for a partial calcanectomy. The procedure utilized a silo-technique with triple antimicrobial bone cement for the residual heel, including curettage of an aneurysmal bone tumor and evacuation of necrotic tissue. Exposed, tunneled structures were covered with collagen wound matrix*, followed by meshed bilayer wound matrix** to support dermal coverage of exposed heel. Negative pressure wound therapy (NPWT) and a modified external fixation device “SALSAstand” were employed to offload the heel [1]. Inpatient spot grafting addressed compromised tissue viability due to central bleeding at the bone site, using dehydrated flaked fish-skin graft. Throughout the postoperative period, careful management of bleeding risks guided local wound care before frame removal. Multiple grafts were applied due to wound size and depth of vital structures, resulting in gradual healing, with notable improvements in tissue tone and turgor. The wound fully healed over approximately six months, initiating rehabilitation followed by two months of prosthetic gait training through physical therapy. After nearly two years of frequent hospitalizations, the patient has regained functional independence.
Conclusion: This case study illustrates the successful management of a vasculopathic patient at high risk for below-knee amputation (BKA) after already experiencing one within the past year. Following bypass surgery, aggressive measures were essential to salvage the remaining limb without compromising the vascular graft. Once healed, the patient transitioned to rehabilitation focused on strength and mobility, primarily for prosthetic gait training on the contralateral limb. This case highlights the critical importance of multidisciplinary management in limb salvage, emphasizing meticulous surgical techniques, surgical offloading, comprehensive rehabilitation strategies, and effective resource allocation for successful limb salvage outcomes.
Recommended Citation
Campbell, Stephanie N.; Verdin, Craig J.; Tran, Heather V.; and Gambhir, Nikita, "Investing in Limb Preservation: A Case Report in Avoiding Bilateral Amputation in a Vasculopathy Patient" (2025). Research Symposium. 159.
https://scholarworks.utrgv.edu/somrs/2025/posters/159
Included in
Orthotics and Prosthetics Commons, Physiotherapy Commons, Podiatry Commons, Surgery Commons
Investing in Limb Preservation: A Case Report in Avoiding Bilateral Amputation in a Vasculopathy Patient
Background: Limb salvage and prosthetics play vital roles in restoring function and mobility for patients with severe injuries or metabolic conditions. Limb salvage involves surgical techniques aimed at preserving a limb rather than resorting to amputation, while prosthetics provide artificial devices to replace lost limbs. Key considerations for limb salvage include restoring a functional foot, maintaining patient independence, minimizing hospitalizations, and avoiding bilateral lower limb amputations.
Case Presentation: The patient, already at single-limb status, presented with a necrotic heel ulcer, exposed calcaneus, and necrotic Achilles tendon. After vascular optimization, the risks and benefits of final aggressive measures were discussed, leading to consent for a partial calcanectomy. The procedure utilized a silo-technique with triple antimicrobial bone cement for the residual heel, including curettage of an aneurysmal bone tumor and evacuation of necrotic tissue. Exposed, tunneled structures were covered with collagen wound matrix*, followed by meshed bilayer wound matrix** to support dermal coverage of exposed heel. Negative pressure wound therapy (NPWT) and a modified external fixation device “SALSAstand” were employed to offload the heel [1]. Inpatient spot grafting addressed compromised tissue viability due to central bleeding at the bone site, using dehydrated flaked fish-skin graft. Throughout the postoperative period, careful management of bleeding risks guided local wound care before frame removal. Multiple grafts were applied due to wound size and depth of vital structures, resulting in gradual healing, with notable improvements in tissue tone and turgor. The wound fully healed over approximately six months, initiating rehabilitation followed by two months of prosthetic gait training through physical therapy. After nearly two years of frequent hospitalizations, the patient has regained functional independence.
Conclusion: This case study illustrates the successful management of a vasculopathic patient at high risk for below-knee amputation (BKA) after already experiencing one within the past year. Following bypass surgery, aggressive measures were essential to salvage the remaining limb without compromising the vascular graft. Once healed, the patient transitioned to rehabilitation focused on strength and mobility, primarily for prosthetic gait training on the contralateral limb. This case highlights the critical importance of multidisciplinary management in limb salvage, emphasizing meticulous surgical techniques, surgical offloading, comprehensive rehabilitation strategies, and effective resource allocation for successful limb salvage outcomes.
