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Reducing Leg Amputation Rates with Coordinated Care

Published: September 4, 2018
Christine Miller, D.P.M., D.M.M., Ph.D., FACCWS
Jason A. Piraino, D.P.M.
Daniel Soffer, M.D.

UF Health specialists are using the latest technology and techniques to save limbs.

Losing a leg can be a life-altering outcome of a complicated condition, but a new program brings several specialists together to reduce delays that can lead to the loss of limbs.

UF Health Jacksonville’s Limb Preservation Program uses a multidisciplinary approach to diagnose and treat patients with limb-threatening conditions, such as diabetes, HIV, AIDS, peripheral artery disease or insufficient blood flow and skin ulcers. People who smoke are also at a higher risk of developing these conditions.

TIME IS TISSUE

Christine Miller, DPM, is a wound care specialist at UF Health Jacksonville and has advanced training to assist patients with diabetes and ulcers who are at risk for amputation.

“Early detection and a multidisciplinary approach are crucial for healing and preventing amputation from ulcerations,” Miller said.

Providers are treating patients who show signs of developing ulcers with compression therapy devices. UF Health Jacksonville is one of the only hospitals in Florida to offer this technology as part of its Limb Preservation Program.

Jason Piraino, DPM, chief of foot and ankle surgery at the University of Florida College of Medicine – Jacksonville, works with Miller to screen and monitor patients for future limb preservation. Screenings include self-monitoring of symptoms and checking blood pressure regularly.

“A simple inspection of the feet in the morning and afternoon and immediate reporting of any suspicious marks, ulcers or changes may be the difference between amputation and simple treatments, such as antibiotics or minor surgical interventions,” Piraino said.

BOOSTING BLOOD FLOW

Providers monitor blood pressure in at-risk patients with limbs that may be in jeopardy from inadequate blood flow. The basic ankle-brachial index test is used to compare the blood pressure in the upper arm to the blood pressure in the leg to make sure they match. When patients show abnormal results or report indications from self-monitoring, Piraino and Miller refer them to a cardiologist.

Daniel Soffer, MD, medical director of endovascular cardiology, brings a unique skill set to the Limb Preservation Program. Not all cardiologists have specialized training or experience treating endovascular conditions. Soffer not only performs cardiovascular procedures, he also works with peripheral vessels from the neck to the toes.

The size or degree of an amputation can be reduced — or even avoided — with a procedure Soffer performs to improve or restore blood flow to the feet. The key is establishing a straight line of blood flow from the heart to the foot, or to where there is tissue damage or loss.

“The technology has improved drastically in the past two decades,” Soffer said. “We have newer tools and devices to help us expand and deliver treatments with more effective outcomes.”

Soffer describes the new balloons and stents as more flexible and they adjust to the vessels in the legs. They are self-expanding and come in different sizes and lengths. In addition, they are now coated with medication to prevent scar tissue from forming to help provide patients with the best possible outcomes.

“An abnormal ankle-brachial index test may mean a decrease in life expectancy and an increased risk for heart attack or stroke,” Soffer said. “This screening program not only preserves limbs, but can also save lives.”  

Visit UFHealthJax.org/ortho for more information about the Limb Preservation Program.

Christine Miller, D.P.M., D.M.M., Ph.D., FACCWS
Jason A. Piraino, D.P.M.
Daniel Soffer, M.D.

For more information, please contact:
UF Health Media Relations
904-244-3268