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There were two key therapeutic approaches to Mr A’s
vascular impairment but the selection of amputation will be the focus of the
evaluation. Mr A’s condition meant that the vascular compromise in his left leg
had caused the distal tissue to become gangrenous and necrotic1.
Thus meaning that the tissue had become irreversibly damaged and even if this
region were to be re-perfused, it would bear no chance of functionality1.
Without amputation of the necrotic tissue, there will be a significant risk of
further limb loss and also sepsis, which may result in death2.
Furthermore, amputation is a beneficial treatment option in the case of
prolonged pain in critically ischaemic limbs3.

Amputation is currently considered to be a treatment
modality only considered when all options for revascularisation have been
explored4. The selection of this treatment seems very appropriate in
the settling of Mr A’s case: a failed revascularisation attempt, imaging which
reveals diseased distal vessels and a current symptom of constant pain. In
addition, the goal of limb salvage shouldn’t dominate the focus of management, as
health professionals should be primarily focused on providing a future quality
of life. Selection of a trans-tibial amputation, allowing preservation of the
knee joint, has also shown to be more beneficial for the patient’s future
mobility because of the reduced energy expenditure5. Mobilising is
an important factor for both the patient’s psychological and functional status
but also for the potentially reduced likelihood of a further amputation of

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Understandably, the impact of amputation on future
psychological and functional wellbeing will need to be explored by the
multi-disciplinary team (MDT)4. Post-operative functional status
cannot be accurately predicted, however, one study found that of 130 amputees
there were 63% whom achieved successful outdoor mobility and independence5.
The healthcare decisions for Mr A followed NICE guidelines and incorporated his
future wellbeing. 

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