Complications with managing a below the knee amputation in a patient with stage 3 lymphedema in the acute care setting

Introduction: Patients with lymphedema are at increased risk for the development of wounds due to the increased diffusion difference between their skin and circulatory system. These complications arise with uncontrolled lymphedema and place patients at increased risk for non-healing wounds, amputations, and mortality due to their altered physiology.Methods:A 61 y.o. African American male with stage 3 lymphedema and DM2 presented to an urban level 1 trauma center with cellulitis to his right lower extremity. Following an emergent open below the knee amputation to address septic shock, the patient had a challenging time healing due to the edema in his leg.  The patient required multiple return trips to the OR for debridement and gradual closure of the wound edges. The lymphedema certified wound care clinician utilized aggressive wound care interventions, including sharp debridement and instillation wound vac, alongside short stretch wraps to address his lymphedema and accelerate wound healing.Results:The patient's residual limb was able to be salvaged by the wound care clinician and trauma team. The patient received a skin graft that did not fully incorporate but allowed for decreased wound area and transition from wvac for discharge home.Discussion: This case highlights the importance of aggressive wound treatment at admission for patients with lymphedema, including implementing short stretch wrapping during inpatient admission. Education regarding management of lymphedema to entire care team is essential for wound healing and limb salvage, along with appropriate wound care interventions.References: