New Program Promotes Effective, Efficient Limb-Saving Care

Lower limb amputations are on the rise nationally, a tread related to the aging of the population and the prevalence of diabetes and peripheral arterial disease (PAD). A new multidisciplinary program at Lehigh Valley Heart and Vascular Institute aims to counter this trend by quickly triaging people with limb-threatening conditions to optimum appropriate care.

This innovative approach, called the Limb Preservation Program, is the only program of its kind in the region. It is led by two vascular surgeons, John Welkie, MD, and Ben Jackson, MD.

“Lehigh Valley Health Network has a strong group of clinicians across several health care specialties who collaborate every day to provide limb-saving care,” says Dr. Jackson, Chief of Vascular and Endovascular Surgery at Lehigh Valley Heart and Vascular Institute. “In the past, however, these efforts weren’t organized under a single umbrella. We believe our new organizational framework will help ensure that no stone is left unturned as we work to save people’s limbs and restore their vibrant lives.”

The Limb Preservation Program is designed to streamline the path through evaluation, treatment planning and care escalation for limb-threatening conditions.

Treatment options include:

• Management of diabetes, PAD and coincident coronary disease
• Wound care
• Podiatric care
• Reconstructive surgery for wounds
• Endovascular arterial revascularization, including ballooning and stenting of arteries
• Arterial bypass surgery
• Hyperbaric oxygen therapy

Providing optimal limb-saving care for a given individual is a team effort. It may involve specialists in vascular surgery, cardiology, wound care, podiatry, plastic surgery, interventional radiology, hospital medicine, endocrinology and infectious diseases.

Bringing on the appropriate specialists as early as possible in a person’s care is crucial. To that end, the Limb Preservation Program is developing inpatient referral and consult order sets as well as outpatient referral orders that are streamlined and comprehensive.

“The bottom line is that the program allows us to triage people effectively and efficiently, and get them seen in the right place for the right care,” Dr. Welkie says.

From a surgical standpoint, Lehigh Valley Heart and Vascular Institute specialists are exploring novel treatments for situations when all other therapeutic options have been exhausted. Among the novel and aggressive approaches to limb salvage are surgical procedures that restore blood flow to the leg (revascularization) or provide robust coverage to help heal wounds.

Procedures include:

• Bypass surgery on the small arteries of the calf and foot
• Bypass surgery to the veins of the calf and foot when no adequate arteries are open (deep venous arterialization)
• Minimally invasive approaches to bypass surgery using wires, catheters, balloons and stents to accomplish revascularization of the arteries or veins
• Free-flap reconstruction – an advanced plastic and reconstructive surgery procedure using microsurgical techniques – of recalcitrant wounds

“Before implementing any new treatment, it is important to carefully consider the clinical indications and potential benefits,” Dr. Welkie says. “The Limb Preservation Program – with its multidisciplinary expertise, involvement and decision-making – is the perfect forum for having these kinds of discussions.”