Houston Methodist Sugar Land Hospital Introduces New Program to Prevent Amputations

Dr. Jean Bismuth and Dr. Charlie Cheng, vascular surgeons.

Houston Methodist Sugar Land Hospital is creating a multi-disciplinary service to help patients avoid limb amputation due to severe vascular disease and wounds in the foot or leg.

The new Limb Salvage Program enables specialists from the hospital’s Wound Care Program and its cardiovascular and general surgery services to coordinate and expedite the diagnosis and treatment of patients who have wounds in the foot or leg, or ulcers due to diabetes or vascular disease.

Foot and lower leg amputations are a serious health issue in the U.S., with more than 180,000 performed each year. About half of the major amputations are performed without any prior diagnostic evaluation.

Amputation patients face an increased risk of depression, significantly higher lifetime medical costs and high revision or re-amputation rates. In fact, statistics show that 5-10 percent of below-knee amputees – and 15-20 percent of above-knee amputees – die in the hospital following their procedures.

“The majority of these amputations are not the result of trauma; they become necessary after patients suffer infection and severe tissue loss due to inadequate blood flow caused by damage to blood vessels from diabetes or blockages caused by vascular disease,” said Charlie Cheng, M.D., a board-certified vascular surgeon with Houston Methodist Cardiovascular Surgery Associates and the Director of the Limb Salvage Program.

“Skin tissue requires adequate blood flow to heal properly, and for patients with diabetes or an underlying vascular issue, even a small cut or scrape on the foot or leg can quickly become serious because there simply isn’t enough blood flow to the wound to allow healing,” he said. “For these patients, time is of the essence, and getting the proper diagnosis and treatment quickly can be the difference between recovering from a wound or losing their toe, foot or leg.”

Cheng says that for many patients, simply treating the wound itself without restoring blood flow to the affected limb is not enough. Through the Limb Salvage Program, wound patients immediately receive diagnostic ultrasound studies to evaluate for arterial and/or venous disease in the affected limb. If necessary, they are promptly scheduled for treatment, such as an arteriogram and endovascular procedures for balloon and stenting, open surgical bypass, or venous interventions. The entire process – from initial visit to revascularization – can now be completed within a few days rather than weeks or months, thereby saving valuable time.

Once blood flow is restored, physicians with the Houston Methodist Wound Care Program at Sugar Land continue to help the patient with a variety of leading-edge treatments, including compression wraps, antimicrobial dressings, bioengineered skin substitutes and hyperbaric oxygen therapy, Cheng said.

Patients typically benefit from a dramatic improvement in their wound once revascularization is complete and reduce their risk of further wound development.

While patients with diabetes are often instructed to take special precautions with their feet and legs, individuals with vascular issues may not recognize they have an issue until they develop a wound or ulcer that won’t heal, Cheng said. It is estimated that 18 million people in the US have peripheral arterial disease. One of the goals of the limb salvage program is to educate people about vascular issues and encourage early identification and treatment.

“If a patient has pain in his or her calf, thigh or buttocks after walking a short distance, or at night in bed, it could be a sign of a blockage or narrowing of the blood vessels in the legs,” said Jean Bismuth, M.D., a board-certified vascular surgeon with Houston Methodist Cardiovascular Surgery Associates and a member of the Limb Salvage Program team. “And while the patient may not have a wound or ulcer yet, the conditions are in place and the likelihood of a problem is much greater. Our goal is to help these patients before they find themselves at risk of amputation.”

Cheng says that studies have shown that revascularization is the appropriate initial treatment protocol in approximately 70 percent of patients who suffer from severe vascular disease, compared to just 15 percent who require amputation.

Patients with symptoms of vascular disease in their legs should schedule an appointment with Houston Methodist Cardiovascular Surgery Associates by calling 832.522.8616.

Patients with an active wound or ulcer should be examined by a wound specialist at the Houston Methodist Wound Care Program at Sugar Land. To schedule an appointment, call 281.275.0770.

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