Limb Salvage of Diabetic Foot Ulcers: Know When to Refer Them

Introduction: A 71- year-old male presented to the wound care center for non-healing surgical wound of his right lower leg and foot for greater than one year. Patient sustained an ankle fracture, which was repaired (open reduction internal fixation) and re-fractured resulting in hardware complications. Pertinent medical history includes diabetes mellitus type 2, CKD, anemia of chronic disease, chronic diastolic CHF, morbid obesity, ex-smoker, atrial fibrillation, HTN and chronic anticoagulation.  Methods:Referral to specialized orthopedic group that treats limb salvage in the setting of contaminated hardware.Results: On admission, the patient was non- ambulatory due to his previous fracture with surgeries and complications. It was impressed upon him that the potential for limb loss was high due to infected hardware and multiple complex comorbidities that contributed to his wound not healing. An immediate recommendation was made for advanced evaluation with a specialized orthopedic group that treats limb salvage in the setting of contaminated hardware. On 07/14/2023- patient had the following surgery: Removal of Hardware/ Right Ankle Fusion with Antibiotic Coated Hindfoot Fusion Rod. The patient was discharged from the hospital on 07/21/2023 to a rehabilitation facility which he discharged from at the end of August of 2023. The patient remained non-ambulatory until October of 2023 when he was fitted for a walking CROW boot. Outpatient physical therapy continued for 8 weeks, and the patient was able to ambulate with a rolling walker as allowed. Currently the patient is ambulatory with a cane for short distances and uses a walker for long distances.  Ankle arthrodesis is the surgical treatment of choice for patients who have failed conservative treatment or joint preserving (distraction arthroplasty) surgery (Van Den Heuvel, S.B., et al 2022). Within the United States of America, the total number of foot and ankle arthrodesis surgeries performed was 56.877 in 2006. 3+ view X-ray of right ankle (pre-surgical).                           Right ankle X-ray- post surgical.                                                      Discussion: Without the appropriate recommendation, this patient was at a high risk of losing his leg. Most importantly, pressing upon the importance of an advanced evaluation with a specialized orthopedic group and patient follow through, made a difference with the outcome.  References: