MARCH 31, 2023 – More than 400 non-traumatic lower limb amputations are performed in the U.S. every day, of which 50% are associated with diabetes. According to the Centers for Disease Control and Prevention (CDC), 154,000 lower-extremity amputations are performed each year in adults with diabetic-associated conditions.
To care for patients with diabetic and other complex vascular conditions, the Heart & Vascular Institute Limb Preservation Program at Tampa General Hospital (TGH) was designed to care for patients with limb ischemia or chronic wounds at risk for amputation.
MULTIDISCIPLINARY APPROACH FOR COMPLEX CASES
The program is the first and only of its kind in the Tampa Bay area and offers a true multidisciplinary, integrated, evidence-based approach to the management and care of patients with complex peripheral arterial disease (PAD). Charles J. Bailey, MD, sees his fair share of preventable amputations, treating patients from a variety of communities, including those with health care challenges and disparities that often create barriers to accessing the collaborative, evidence-based approach to care that provides then with the best chance of limb salvage.
“Our program coordinates care from vascular surgery to specialists that are integral to limb salvage, including wound care, infectious disease, podiatry, plastic surgery and rehabilitation therapy,” Dr. Bailey said. “Treatments for PAD include medical therapy for both primary and secondary disease prevention.” The need for cross-specialty care is key, he emphasized. “Our team of surgeons and specialists embrace the newest research and technology and work as partners to provide a treatment plan as unique as each patient.
RESEARCH
Dr. Bailey and the multidisciplinary team at the TGH Heart & Vascular Institute (HVI) Vascular Center of Excellence are among the leading experts in the treatment of PAD and end-stage Chronic Limb-Threatening Ischemia (CLTI). Dr. Bailey pointed to peer-reviewed research showing that multidisciplinary care is recommended for the treatment of patients with the ischemic and diabetic wounds that can result from CLTI. “A risk factor for PAD and a common catalyst for amputation is diabetes,” Dr. Bailey said. “According to the Centers for Disease Control and Prevention (CDC), 154,000 lower-extremity amputations are done each year in the U.S. for adults who are diabetic.” Estimates show that more than 400 non-traumatic lower-limb amputations are performed per day,” he added. “As many as 50% of those non-traumatic lower-extremity limb amputations are associated with diabetes.”
Outpatient clinics like the satellite facility opened by TGH, incorporates a wound care team, exemplifying the multidisciplinary approach and dedication to comprehensive follow up care for patients with atrial fibrillation (AFib).
OPENING OF SATELLITE CLINIC
New TGH Atrial Fibrillation Clinic
In March 2023, The TGH Heart and Vascular Institute opened a new satellite clinic to offer a truly multi-disciplinary, integrated and evidence-based approach to the management and care of patients with complex PAD. The new program seeks to prevent limb amputations through early identification and treatment of patients with critically low limb blood flow due to a severe blockage in the arteries (limb ischemia or non-healing leg wounds).
“The team is acutely aware of the need for such a satellite clinic in the Tampa area, away from the main campus,” Dr. Bailey said, “in order to tackle some of the most challenging outcomes associated with CLTI, one of which is non-healing wounds.” The new clinic will offer patients at risk for limb loss convenient access to comprehensive wound care, podiatry services and vascular care, tailoring treatment plans to meet the unique needs of the patient and ensure the best outcome – with the goal of saving a functional limb and providing a higher quality of life for the patient.
The new satellite clinic will also offer limb preservation treatments ranging from specialized wound care and goal-directed medical therapy for vascular diseases to open vascular bypass and minimally invasive stent therapies. Surgeons at the TGH Heart & Vascular Institute are also actively involved in clinical research, including participation in the BEST-CLI trial to help determine whether stent or surgical treatments are more effective for critical limb-threatening ischemia.
To coordinate care, a Limb Preservation Program coordinator and vascular services nurse navigator to arrange an evaluation by a vascular, wound or podiatry specialist, and do a complete review of their medical history and previous medical procedures.
Patients and conditions treated by Tampa General’s Limb Preservation-PAD Program include:
- Patients with a history of peripheral arterial disease (PAD)
- Leg pain from lack of blood flow
- Diabetic foot infections or neuropathic ulcers
- Non-healing lower extremity wounds or ulcerations
The Limb Preservation Program also features a first-of-its-kind Limb Alert system developed by Dr. Bailey to expedite the diagnosis and management of patients with acute limb ischemia, designed to prevent limb loss. For example, if a patient comes to Tampa General Hospital with an infected wound or restricted blood flow to a limb, the Limb Alert is activated, which, similar to a hospital Code Blue, immediately notifies the Limb Preservation Program team.
“Limb salvage and an amputation-free survival is directly dependent on how fast we can diagnose and reverse the problem. The Limb Alert allows our team to rapidly diagnose and restore blood flow in order to improve limb salvage potential,” Dr. Bailey said.
Many non-traumatic amputations are preventable, and programs like the TGH Limb Preservation Program have proven to reduce amputation rates and improve quality of life for PAD patients.
