From the Guidelines
The best next step for a patient with diabetes mellitus, poor wound healing, and significant popliteal artery stenosis after below-knee amputation is to manage the patient with a multidisciplinary team as part of a comprehensive care plan.
Key Considerations
- The patient should be evaluated and provided comprehensive care by an interdisciplinary care team to achieve complete wound healing and a functional foot 1.
- Revascularization should be coordinated with the efforts of clinicians who manage foot infections, provide offloading, and achieve complete wound healing 1.
- The management of patients with CLI and nonhealing wounds should include coordinated efforts for both revascularization and wound healing 1.
- Negative-pressure wound therapy dressings may be helpful to achieve wound healing after revascularization and minor amputation when primary or delayed secondary closure is not feasible 1.
Treatment Approach
- The patient's treatment plan should include treatment of infection, frequent debridement, biomechanical offloading, blood glucose control, and treatment of co-morbidities 1.
- Revascularization may not be appropriate for patients who are severely frail, have a short life expectancy, have poor functional status, or are bedbound or those with a large volume of tissue necrosis that renders the foot functionally unsalvageable 1.
- The decision to perform revascularization should be made on a case-by-case basis, taking into account the patient's individual factors, such as morphological distribution of PAD, availability of autogenous vein, patient co-morbidities, and local expertise 1.
From the Research
Management of Diabetes Mellitus and Wound Healing
- The patient's condition of diabetes mellitus, poor wound healing, and significant popliteal artery stenosis after below-knee amputation requires a comprehensive approach to management 2, 3, 4, 5, 6.
- Improved glycemic control plays a significant role in lowering the risk of wound healing complications 4.
- The use of alternative treatments such as low-level laser therapy (LLLT) has shown potential in promoting wound healing in patients with diabetic foot ulcers 2.
- Hyperbaric oxygen therapy (HBOT) has also been suggested to improve the healing of diabetic foot ulcers and decrease the risk of lower extremity amputations 3, 6.
Treatment Options
- LLLT can provide benefits in patients with diabetic foot ulcers and uncontrolled diabetes, with minimal adverse effects 2.
- HBOT has been shown to be effective in reducing wound size and promoting healing in patients with diabetic foot ulcers 3, 6.
- A comprehensive foot care program, including early screening and evaluation, foot care education, preventive therapy, and referral to specialists, can reduce amputation rates by 49-85% 3.
- Other treatment options, such as wound patches, oxygenation therapy, hydrogel patches, gene therapy, laser therapy, and stem cell therapy, may also be considered for the management of diabetic wounds 5.
Considerations for Popliteal Artery Stenosis
- Significant popliteal artery stenosis may require vascular surgery consultation to assess the need for revascularization or other interventions to improve blood flow to the affected limb 3, 6.
- The decision to amputate should be made by a vascular surgeon, taking into account the patient's overall condition and the viability of the affected limb 6.