There were two key therapeutic approaches to Mr A’svascular impairment but the selection of amputation will be the focus of theevaluation. Mr A’s condition meant that the vascular compromise in his left leghad caused the distal tissue to become gangrenous and necrotic1.Thus meaning that the tissue had become irreversibly damaged and even if thisregion were to be re-perfused, it would bear no chance of functionality1.Without amputation of the necrotic tissue, there will be a significant risk offurther limb loss and also sepsis, which may result in death2.Furthermore, amputation is a beneficial treatment option in the case ofprolonged pain in critically ischaemic limbs3.
Amputation is currently considered to be a treatmentmodality only considered when all options for revascularisation have beenexplored4. The selection of this treatment seems very appropriate inthe settling of Mr A’s case: a failed revascularisation attempt, imaging whichreveals diseased distal vessels and a current symptom of constant pain. Inaddition, the goal of limb salvage shouldn’t dominate the focus of management, ashealth professionals should be primarily focused on providing a future qualityof life. Selection of a trans-tibial amputation, allowing preservation of theknee joint, has also shown to be more beneficial for the patient’s futuremobility because of the reduced energy expenditure5. Mobilising isan important factor for both the patient’s psychological and functional statusbut also for the potentially reduced likelihood of a further amputation oftrans-femoral. Understandably, the impact of amputation on futurepsychological and functional wellbeing will need to be explored by themulti-disciplinary team (MDT)4.
Post-operative functional statuscannot be accurately predicted, however, one study found that of 130 amputeesthere were 63% whom achieved successful outdoor mobility and independence5.The healthcare decisions for Mr A followed NICE guidelines and incorporated hisfuture wellbeing.