Reclaiming Autologous Amputated Tissue for Limb Salvage of a Diabetic Foot Burn with Underlying Critical Limb Ischemia

Catherine N. Tchanque-Fossuo, Andrew M. Wishy, Kaitlyn I.M. West, David L Dawson, Sara E. Dahle, John G Carson

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

BACKGROUND: Diabetes mellitus is a worldwide pandemic that impacts more than 387 million people, with 29 million individuals affected in the United States alone. Diabetic patients have a 25% lifetime risk of developing a diabetic foot ulcer (DFU). Having a DFU is associated with a risk of recurrence approaching 70%. In addition, 1 in 6 patients with DFU will have a lower-limb amputation, with an associated increase in mortality ranging from 47% to 70%. Therefore, limb salvage is critical in patients with DFU. CASE STUDY: This article describes the case of a 70-year-old man with diabetes mellitus, end-stage renal disease, and peripheral arterial occlusive disease who presented with a 1.5% total-body-surface-area, third-degree burn to the left hallux with dry gangrene extending to the midfoot. Ankle brachial indexes were 0.66 on the left and 0.64 on the right. Toe pressures on the left were absent because of extensive dry gangrene. His right foot had a prior transmetatarsal amputation. Using a retrograde pedal approach, a chronic total occlusion of the left posterior tibial artery was recanalized with balloon angioplasty. He then underwent a transmetatarsal amputation with closure, except that the plantar medial side could not be closed without tension. Therefore, an autologous full-thickness skin graft, from the amputation specimen, was used to bridge the defect. DISCUSSION: At 32-week follow-up, the wound was healed, the graft had fully incorporated, and the patient was ambulating well using custom orthotic footwear. The creative use of amputated tissue to assist with wound coverage has not been well described in the literature.

Original languageEnglish (US)
Pages (from-to)596-600
Number of pages5
JournalAdvances in Skin and Wound Care
Volume31
Issue number1
DOIs
StatePublished - Jan 1 2018

Keywords

  • amputated tissue
  • autologous full-thickness skin graft
  • diabetes mellitus
  • diabetic foot ulcer
  • gangrene
  • limb salvage
  • transmetatarsal amputation

ASJC Scopus subject areas

  • Dermatology
  • Advanced and Specialized Nursing

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