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REVIEW  SAVE THE SEVERELY ISCHEMIC LIMB: THE JOINT PRACTICAL APPROACHES Freefree

Italian Journal of Vascular and Endovascular Surgery 2020 December;27(4):217-25

DOI: 10.23736/S1824-4777.21.01494-7

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Sparing the heel, the final and essential complementary treatment: the stump in the foot must heal

Gennaro VIGLIOTTI 1 , Michele DI LORENZO 1, Daniela VIOLA 1, Anna PETRONE 2, Rossella C. VIGLIOTTI 3

1 Unit of Vascular Surgery, Ospedale del Mare, Naples, Italy; 2 Unit of Vascular Surgery, Department of Public Health, Federico II University, Naples, Italy; 3 Division of Vascular Surgery, Department of Medical, Surgical, and Experimental Sciences, University of Sassari, Sassari, Italy



Severely ischemic limbs are very often destined for amputation; therefore, the role of the vascular surgeon in the treatment is crucial. Whenever is possible, revascularization is the first step to maximize blood flow to the foot. Foot ulcers are very often complicated by infection. In fact, the vascular surgeon, after endovascular or surgical revascularization, must treat gangrene secondary to ischemia. The type of procedure and/or amputation depends on the extent of the lesion: the goal is to save the heel in order to preserve an independently walking and, therefore, to improve the quality of life of this type of patients. During lower extremity amputation, the objective was to provide a functional residual limb that offer maximum patient mobility and independence. Preservation of length of the anterior part of the foot, using salvageable tissue from the amputated part, prevents deformity and revision of amputation to a higher level. The goal in all cases is to maintain foot function and preserve structure. However, in some cases, where the soft tissue has been lost or where an infection or circulatory disorder makes the forefoot non-viable, amputation could be considered an appropriate option. The non-healing of the stump is the most serious complication of surgery; however, the healing of the stump represents the final goal for the vascular surgeon, because it allows a good walking with a suitable prosthesis. The presence of comorbidities represents another predictive factor for the healing of the stump; in fact, diabetes mellitus is one of the factors that complicate healing. Sometimes the stump fails to heal, and may be necessary to use hyperbaric oxygen therapy, negative pressure therapy, growth factor delivery systems or skin graft to assist in the healing of the stump.


KEY WORDS: Vascular surgical procedures; Heel; Surgical procedures, operative

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