Coordinated care between Washington University plastic and reconstructive surgeon, Dr. Mitchell Pet, and orthopedic trauma surgeon, Dr. Christopher McAndrew, successfully treated a patient with a hardware association infection of his recently fixated tibia. After thorough debridement of his multiple wounds and skeletal stabilization, soft tissue coverage was re-stablished using a chimeric latissimus and serratus anterior myocutaneous free flap.
In matters of life and limb, time and attention are crucial.
The multidisciplinary team of Washington University specialists at Barnes-Jewish Hospital are answering both of those needs. The Washington University Limb Preservation Program was established to connect patients facing amputation with all the medical specialists they will need to save their limb, in the shortest amount of time.
“We’ve created a common focal point for patients whose limbs are threatened, whether it be from trauma or cancer or peripheral vascular disease,” says the program’s director, Dr. Justin Sacks, Washington University’s Chief of the Division of Plastic and Reconstructive Surgery, who treats patients at Barnes-Jewish Hospital.
With access to a focused team, doctors can expedite care by referring patients with traumatic injuries or limb-threatening medical conditions directly to the program. Shorter paths to complex care translate into fewer amputations and lower risks of infections, tissue damage and loss of function in the limb or remaining tissues.
The Washington University doctors who are part of the program come from a variety of specialties, but all are focused on preserving arms and legs and as much function as possible. Each patient has access to a care team with experts from these specialties:
- acute and critical care surgery
- orthopedic surgery
- vascular and endovascular surgery
- plastic and reconstructive surgery
The collaboration provides patients with access to a broader range of specialists. This enhances communication with patients and between doctors, expedites treatment and saves time for patients.
Dr. Christopher McAndrew, Washington University orthopedic surgeon at Barnes-Jewish Hospital, recognized a need for more efficient limb-preservation care processes several years ago, particularly in orthopedic trauma cases.
“The most important part of this was that it was hard for patients with complex problems to see multiple people at different times,” he says. Dr. McAndrew coordinated clinic with his partners Dr. David Brogan and Dr. Martin Boyer, who specialize in microvascular surgery to transfer tissue and cover open wounds. After recognizing the impact of coordinated follow-up care for patients treated in the acute setting at Barnes-Jewish Hospital, the group set aside additional clinic time to take referrals for patients with similar problems that have resulted from injuries previously treated elsewhere. Whether for acute injury or for chronic problems following injuries, coordinated and collaborative care helps identify new solutions to complex problems to save limbs.
“The idea was to have a more centralized experience to see at least two of the people [at once] who would be collaborating to address their problems,” Dr. McAndrew says. “I think the next level of this is to just add additional perspectives and expertise to make that experience even better.”
As the program grows in scope, adds Dr. Sacks, the goal is to apply the same multidisciplinary team model to potential arm amputations, as well as to tissue transplant cases.
Multidisciplinary Approach to Care
Each patient in the Limb Preservation Program is triaged to a care team staffed with the most appropriate medical specialties for their condition, says Dr. Sacks. For example, a patient with traumatic injuries may require a trauma surgeon and plastic surgeon, while an individual with limb-threatening diabetic neuropathy may benefit more from a specialist in vascular surgery.
In multiple studies led by Dr. Patrick Geraghty, Washington University vascular surgeon at Barnes-Jewish Hospital, doctors examined complex cases of peripheral artery disease (PAD) and chronic limb-threatening ischemia (CLTI) treated in the Limb Preservation Program. By collaborating with plastic surgeons with complimentary skill sets, the team was able to perform vital wound closers, debridement of soft tissue infections, revascularizations and free tissue transfers in a timely manner. This sets the stage for more complete coverage of underlying bones and tendons and better wound healing.
The Washington University Limb Preservation Program is participating in the Vascular Quality Initiative to collect valuable data on their vascular procedures, measure long-term outcomes and further improve care.
“This is how I’d like to be treated as a patient myself,” says Dr. Sacks.
The Washington University Limb Preservation Program is singularly focused on helping patients avoid amputation from traumatic injury or disease complications. Conditions treated include but are not limited to:
- Limb deformities
- Diabetic foot ulcers
- Peripheral arterial disease
- Limb-threatening ischemia
- Venous disorders and vascular anomalies
If a limb cannot be saved, treatment pivots to performing amputations that maximize residual limb function, reducing pain (including phantom limb pain) and collaborating with physical medicine and rehabilitation specialists, prosthetists, and therapists to regain independence. “Preservation of limb function doesn’t stop when a part of a native limb can’t be saved. While the treatments look different, the goal remains the same: to give the patient their life back despite their limb problem,” says Dr. McAndrew.
To make a referral to the Washington University Limb Preservation Program, call 314-273-5462 (LIMB).
  Limb Preservation Beyond Revascularization: Multidisciplinary Approaches to Ensuring Sustained Outcomes - Endovascular Today (evtoday.com)