Tyson O Strom*, Brennen L O’Dell, Rebecca A Burmeister and Michigan Medicine

Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan Medical School, Domino's Farms, USA

*Corresponding Author: Tyson O Strom, Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan Medical School, Domino's Farms, USA.

Received: August 12, 2022; Published: October 12, 2022

Abstract

Introduction: Limb salvage is often a topic of discussion in diabetic foot management, but certain cases of non-diabetes related foot complications also require limb salvage. The development of gangrene is one such disease. Gangrene can be caused by atherosclerotic disease such as peripheral arterial disease (PAD) or by the effects of vasopressor medications used in life saving measures. Treatment for gangrene is typically surgical intervention in the form of amputation. To preserve limb length and function a period of demarcation is usually employed before amputation. There is no specified time for complete demarcation so timing should be made on an individual patient basis.

Case Presentation: The authors present a case of vasopressor induced bilateral lower extremity vast gangrene in a 40-year-old female who had a Type 1A aortic dissection and subsequent surgical repair. The patient had a complicated hospital course including septic shock requiring vasopressor medication for life saving efforts. The patient developed bilateral lower extremity vast gangrene secondary to vasopressor use. She underwent a left below knee amputation (BKA) at 14 weeks after admission. Decision was made to allow complete demarcation of right sided lower extremity tissues before any surgical intervention. At 6 months post-admission the patient underwent a right transmetatarsal amputation (TMA) with hallux rotational flap. The patient healed all surgical sites and is ambulating with a left leg prosthesis and right foot custom accommodative orthotic.

Discussion: Current literature does not reveal a specified time to wait for demarcation before amputation in cases of lower extremity gangrene, as each patient presents a unique situation. Current literature does agree that higher level amputations correlate with increased disability and lower patient satisfaction and quality of life scores. Therefore, all efforts should be made to avoid high levels of amputation.

Conclusion: In this unique case report, a patient who was initially presented with the option of bilateral BKAs was able to avoid the double major amputation and likely increased disability by choosing to allow a 6-month period of demarcation of soft tissues.

Keywords: Demarcation; Gangrene; Vasopressor

References

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Citation

Citation: Tyson O Strom., et al. “Allowing Demarcation in a Case of Pedal Gangrene Secondary to Vasopressor Use". Acta Scientific Orthopaedics 5.11 (2022): 79-83.

Copyright

Copyright: © 2022 Tyson O Strom., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.