Foot Ulceration in the Immunosuppressed Population: Surgeon Beware!Elliot T. Walters, MD; Kareem Termanini, MS; Brandon T. Jackson, MS; Tara M. Chadab, MS; Jessica S. Wang, MD; Sarah R. Sher, MD; and Karen K. Evans, MD
Introduction. Over the past 3 decades, advances in transplant surgery have allowed life-saving renewal of solid organ function. Many of these patients are predisposed to the development of lower extremity wounds. There is a paucity of data describing treatment, utilization, and outcomes of this complex patient population.
Objective. This study examines the surgical outcomes of these patients and overall limb salvage rates in a tertiary care center with a multidisciplinary team focused on limb salvage.
Methods. Medical records were reviewed for all patients who presented with a foot wound and functioning solid organ transplant who received surgery (including debridement or toe/foot/limb amputation) at the authors’ institution from 2010 to 2017.
Results. Fifty-nine patients were identified: 40 with a kidney transplant, 13 with combined kidney-pancreas transplant, and 6 with a liver transplant. The average solid organ transplant patient received 6.5 (± 4.8) procedures during the follow-up period (46 months; range, 6.8-149.4). Thirty-two patients (54.2%) required toe amputations; 15 of 32 (46.9%) of these healed, 14 of 32 (43.8%) progressed to a midfoot amputation, and 8 of 32 (25%) progressed to a below-knee amputation (BKA). Of patients with hind foot wounds, 11 of 15 (73.3%) required calcanectomy; of these, 7 of 11 (63.6%) progressed to a BKA. Overall, 19 of the 59 (32.2%) patients required BKA, including the 15 who progressed from lesser procedures; 2 of the 19 patients requiring BKA progressed to an above-knee amputation.
Conclusions. This retrospective study highlights the morbidity associated with foot ulceration in the immunosuppressed patient population with an overall BKA rate of 32.2%. Solid organ transplant patients who develop lower extremity wounds require a high level of surgical care. A large proportion of these patients will eventually require a major lower extremity amputation. Further research is needed to develop more effective strategies to salvage the lower extremity in the immunosuppressed patient.
Citation: Walters ET, Termanini K, Jackson BT, Chadab TM, Wang JS, Sher SR, Evans KK. Foot ulceration in the immunosuppressed population: surgeon beware! Poster presented at: Symposium on Advanced Wound Care Spring; May 7-11, 2019; San Antonio, TX.
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