This study included patients who presented with at least one chronic nonhealing
ulcer and had been told by their referring physician that they would require
amputation at the transmetatarsal level or higher. Hospital records of all patients seen in a comprehensive wound-healing clinic from August 1984 through January 1986 were reviewed. Twenty-four patients with 27 lower extremity
ulcers were identified. An aggressive clinical
wound care protocol, including arterial revascularization, control of
infection, wound debridement, protective orthotics, and use of topically applied autologous
Platelet-Derived Wound Healing Formula, was used to heal these chronic
ulcers. With follow-up time ranging from 12 to 22 months, complete wound healing was obtained in 18 of 24 patients (75%), and
limb salvage was obtained in 20 of 24 patients (83%). Of the 24 patients, 18 (75%) achieved wound healing and a functional limb; 16 of the 18 (67%) were ambulatory, and two (8%) had a functional limb for transfers, but were not ambulatory due to preexisting
stroke. We conclude that an aggressive, comprehensive
amputation intervention program can prevent the emotional, functional, and economic costs of limb loss in most high-risk patients.