Amputation Prevention Center
Preserving Your Patients’ Limbs
As a physician, you have certainly seen the escalating numbers of patients suffering from diabetes — first-hand, in your practice. Diabetes impacts 24 million people in the U.S. and 189 million people worldwide. By 2025, that number is expected to soar by 72% to 324 million people globally. The proportion of Americans with diabetes is projected to double over the next 10 years.
While the number of patients with diabetes continues to rise, the medical community continues to improve diabetic care, increasing the life expectancy of these patients. As a result, end-stage complications of this chronic disease are becoming more prevalent. These include lower-extremity complications such as peripheral arterial disease, peripheral neuropathy, foot ulcers, infections, and Charcot foot — all of which significantly increase the risk of limb amputation.
Diabetic lower-extremity amputation is a prevalent and growing epidemic across our nation, and right here in Los Angeles.
- Over the last 15 years, the U.S. rate of diabetic-foot amputations has soared to nearly 100,000 annually
- More than 60% of non-traumatic amputations in the U.S. are performed on patients with diabetes
- The amputation rate is 10 times higher in people with diabetes than those without diabetes
- Every 30 seconds, somewhere in the world someone with diabetes loses a limb
- The International Diabetes Federation and World Health Organization estimate that 85% of diabetic amputations are preventable
- L.A. has one of the highest diabetes-related amputation rates in the country
- Studies show that patient vigilance and better medical care could prevent a majority of diabetes-related amputations
At the Amputation Prevention Center, we partner with physicians and diabetic patients to save limbs, heal wounds, and preserve limb function.
An Innovative, Integrated Approach to Limb Salvage
One of the nation’s only facilities of its kind, the Amputation Prevention Center at Valley Presbyterian Hospital brings a uniquely integrated and highly effective approach to limb preservation. Here, your patients receive intervention and treatment from an interdisciplinary team that includes Board-certified vascular and podiatric surgeons who specialize in limb salvage. The future of amputation prevention, this team-based integrated approach has generated excellent patient outcomes — reducing limb loss rates by 72%.
Involving Physicians in Limb Preservation
Here at the Amputation Prevention Center, physicians and their patients play a key role in our integrated approach. Our surgical and wound care specialists keep you informed of your patients’ progress and healing rates with ongoing consults and access to information.
Equipped with one of the region’s only 3D wound cameras, we capture and share with you images of your patients’ exact wound dimensions to predict and monitor healing. We’ll also provide ongoing patient education that allows your patient to become an active participant in proper foot care and prevention. Our priority is to save the limb, and return the patient to your care.
Risk Assessment and Early Intervention
Up to 20% of patients with diabetes will develop an ulcer over their lifetime. Because many diabetic patients also suffer from sensory loss as a consequence of peripheral neuropathy, they may not even realize they have an ulcer or tissue damage. These patients, and their physicians, must be ever vigilant for signs of lower-extremity complications.
Patients with diabetes should undergo regular foot exams at least annually, and even more frequently depending on the patient’s risk class. The American Diabetes Association also recommends an examination of the peripheral circulation every five years. If your patient presents red, sore or warm spots, blisters, corns, calluses, cuts, scrapes, ingrown toenails, infections, trauma, swelling, numbness or other foot problems, it’s time to consult with a diabetic foot specialist.
At the Amputation Prevention Center, our interdisciplinary team performs a series of risk assessment and diagnostic procedures for patients at risk for developing serious complications.
- Using evidence-based models, we place patients in risk categories based on their estimated likelihood for developing a foot ulcer over the next year.
- Using advanced tools, we check for sensory loss in the feet via biothesiometry, peripheral macro-circulation and micro-circulation with hyperspectral imaging, and skin perfusion pressure with laser Doppler. We also look for foot deformities or joint problems that may increase the risk of wounds.
- With our thermal imager, we can detect inflammation as a sign of tissue breakdown before an ulcer occurs. We prescribe protective shoes and foot thermometers that monitor skin temperature to gauge the risk of ulcer development.
- We provide one-on-one education and individualized strategies for ulcer prevention while minimizing the impact on the patient’s daily life.
Treating the Patient at Risk for Amputation
As a result of our integrated approach combining vascular and podiatric surgery, the Amputation Prevention Center at Valley Presbyterian Hospital has seen significantly reduced rates of amputations for diabetic patients. We offer a range of advanced and effective procedures for limb salvage, using the latest technologies including one of the region’s only hydroscalpels, 3D wound cameras, and a newly renovated operating room equipped for reconstructive and vascular surgeries.
Our hospital setting allows us to offer patients 24/7 emergency coverage as well as quick access to inpatient and OR services. We work closely with our Emergency Department to streamline the delivery of limb salvage care. Additional consultations are provided quickly, and we encourage provider-to-provider communication on referrals.
For many diabetic patients with at-risk limbs, a combination of revascularization and reconstruction can save a limb that might otherwise require amputation. At the Amputation Prevention Center, ours is one of a handful of teams in the nation that combines the expertise of onsite vascular and podiatric surgeons who collaborate to save limbs.
For diabetic patients with at-risk limbs and atherosclerosis that require maximal flow to heal wounds, our Board-certified vascular surgeon has extensive experience in revascularization via open bypass or endovascular. We offer a very high success rate in saving limbs with impaired circulation.
Charcot Foot Reconstruction
Charcot foot is a consequence of peripheral neuropathy and osteopenia combined with minor trauma. The bone may fracture or the ligaments weaken so that they can no longer support the arch of the foot, causing the bones to sublux or dislocate. This leads to tissue breakdown, causing ulcers. Unable to feel the pain, the patient continues to walk on the injured foot, worsening the damage.
In the past, amputation was often the end result of Charcot Foot. At the Amputation Prevention Center, we specialize in Charcot Foot reconstructive surgical procedures, including utilizing external fixation technologies that enable us to preserve the foot, limb and limb function. Our surgeons received their training in the famed Ilizarov Institute in Russia, where the technology was developed.
Stem Cell Therapy
Our podiatric surgeons have been actively involved in groundbreaking clinical trials and award-winning research advancing the use of marrow-derived stem cell therapy and regenerative medicine to heal chronic foot ulcers.
Negative Pressure Wound Therapy (Wound V.A.C.)
We use V.A.C. negative pressure wound therapy to promote wound healing. Clinically proven to heal non-responsive wounds, V.A.C. therapy works by applying a vacuum at the wound site, drawing wound edges together, removing infectious materials and promoting faster tissue regeneration and healing at the cellular level. V.A.C. therapy is often used in combination with other treatment for best results.
Bioengineered Skin Tissue Grafts
Bioengineered skin tissue grafts have demonstrated excellent results in promoting faster and more complete healing of chronic and hard-to-heal wounds. In this type of procedure, our surgeons apply engineered skin grafts from donated neonatal foreskins to the wound and carefully monitor the wound’s progress to ensure it heals properly.
In severe cases where amputation is necessary in order to prevent the spread of infection, our surgeons concentrate on preserving as much as the limb and limb function as possible. Advances in limb-sparing surgical techniques, partial amputation and prosthetic technologies have allowed many patients to regain much of their mobility.
Advanced Techniques for Wound Closure
Wound closure is critical to wound healing, and to preventing the likelihood of infections returning. Our team of surgical wound care specialists excels in a range of plastic surgical techniques to achieve wound closure, including skin flaps, skin grafting, and mechanically assisted wound closure using skin-stretching devices.
Schedule a Consult
The team at Valley Presbyterian Hospital’s Amputation Prevention Center invites you to schedule a consultation with our limb salvage specialists, and tour our state-of-the-art facilities. We share your commitment to providing exceptional care and preserving your patients’ quality of life. Contact us today.