| 47 | Case Study/Series |
Multidisciplinary limb salvage using endovascular intervention and bi-layered skin substitute in patient with critical limb ischemia Authors: De Anna Bell, MSN, ARNP, BC, CWS, DAPWCA, Desmond P. Bell, Jr., DPM, CWS, FCCWS, FAPWCA, Yazan Khatib, MD, FACC, FSCAI An 80 year old man with a history of a recurrent left foot ulcer of 11 years was treated successfully through the combined efforts of a Nurse Practitioner, Interventional Cardiologist, and Podiatrist. A home health nurse consulted the Nurse Practitioner as the patient was about to be discharged for failing to show progress in the healing of his wound. Patient was found with maggot infested ulcer, irregular with raised edges, tendon exposed, foul smelling drainage and exquisite pain upon elevation of lower extremity. Patient was hospitalized for wound management and suspicion of underlying critical limb ischemia, osteomyelitis, and concern of possible carcinoma within the foot. Interventional Cardiologist was consulted and Silverhawk procedure was performed on left leg. Biopsy of foot ulcer initially revealed concern of angiosarcoma. Osteomyelitis was ruled out on x-ray and MRI. Daily pulse lavage, along with daily dressing changes, was performed, while second opinion obtained from additional Pathologist ruled out angiosarcoma in favor of hypergranulation tissue. Bi-layered living skin substitute was applied to ulcer by Podiatrist after significant improvement of ulcer, status post Silverhawk and diligent wound care. This illustrates the importance of team approach, and use of multiple technologies in a complicated limb salvage case. |
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