The definition of limb salvage is saving a lower extremity that would have otherwise been amputated. There is excellent evidence that using a multidisciplinary team results in lower amputations rates. Despite this supporting literature, the concept has been slow in universal acceptance and a large number of primary amputations are still occurring today, resulting in significant morbidity, loss of function and independence and reduced quality of life, high mortality rates and increased healthcare costs.
In 2012, the total healthcare cost related to diabetes were $245 billion, accounting for 25% of all Medicare expenditures. The direct medical cost related to diabetes, $176 billion were more than twice the direct costs of treating people without diabetes. The remaining $69 billion are the indirect costs of diabetes due to disability, lost time at work and premature death. With the future incidence of diabetes projected to rise to 550 million people worldwide by the year 2030, the concept of limb salvage has become an international and national trend.
Mortality rates following primary amputation reach up to 40% at one year postoperative and 80% at five years. Mortality rates secondary to diabetic foot ulceration and diabetic foot ulceration related amputations exceed the combined mortality rate of prostate cancer, breast cancer and Hodgkin’s lymphoma.
Value of an Integrated Multidisciplinary Limb Salvage Team
Ideally, the treatment should be evidence-based, cost-effective, low in morbidity and mortality and improve the patient’s quality of life.