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Case Study
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Critical limb ischemia (CLI): the intersection between wound care and vascular services William J. Ennis, DO, Suren Avula, MD, Patricio Meneses, PhD. Introduction: Historically, vascular surgery services have provided complete care for patients with critical limb ischemia. Primary patency of surgical revascularization was considered the gold standard benchmark for success. With an aging population that currently includes 2 million patients with critical limb ischemia, and the availability of new, less invasive options for revascularization a partnership between wound care and vascular services is of paramount importance. Increasingly patients with ulcerations and critical limb ischemia are presenting to wound care departments as their first point of contact to the health care system. Wound care practitioners need to become ÒfluentÓ in the diagnosis, treatment, and follow-up for these medically complex wound care patients Case History:.A 59-year-old woman with diabetes with necrobiosis and a painful leg ulcer presented to the wound care center with critical limb ischemia. The patient had undergone multiple bypass procedures in the affected limb with no available remaining vein, high surgical risk and a history of non-compliance. After multidisciplinary team review the patient was admitted, underwent diagnostic angiography, cool laser assisted angioplasty and stent placement. Rest pain was relieved, the patient was discharged and wound bed preparation was performed followed by autologous split thickness skin grafting. Despite persistent tobacco use, the patient is fully ambulatory, free of pain and ulcer free at 3-years follow-up Summary: This case study with angiographic and clinical photographs will describe the importance of communication and teamwork between the interventional vascular service and the wound care team in order to achieve limb preservation for a medically complex patient with a wound and critical limb ischemia. |
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