Long Beach Memorial Medical Center
Title: Tools for decision making in diabetic foot ulcers
Michael Strauss is an Orthopedic surgeon with a long-standing interest in diving medicine and using hyperbaric oxygen to aid wound healing. He is Medical Director of Hyperbaric Medicine at Long Beach Memorial Medical Center, Long Beach, California and Clinical Professor of Orthopedic Surgery at the University of California Irvine School of Medicine. Dr. Strauss has developed many minimally invasive surgical techniques to avoid amputations of serious wound problems in the lower extremities. He has published over 100 papers, abstracts and book chapters on orthopedic, hyperbaric medicine and diving subjects. He is presently completing a text entitled MasterMinding Wounds; this follows his recently published Diving Science text.
Introduction: When one hears of thousands being spent to salvage a diabetic foot problem only to go onto a lower limb amputation, the need for objective criteria for decision making between limb salvage versus amputation (SvA) is apparent. This presentation provides 2 objective scoring tools to justify the SvAdecision.
Methods: It was apparent that scoring tools were neededto provide guidance for making the crucial decision of SvA. A Wellness Score (WS) and a Goal Score (GS) I that I generated solved this problem. Each is based on 5 objective assessments graded from 2 (best) to 0 (worst). This generates a 0 to 10 score for each tool. We utilized these tools in a series of patients where the crucial decision of SvA needed to be made.
Findings: The use of the WS & GS provided justification for SvA and was especially useful for the diabetic with a limb threatening Charcot foot ulcer. All patients where a SvA decision needed to be made and an amputation was done scored less than 5 points on either or both of the WS &GS. When the patient (and/or person providing the durable power of attorney) was informed of the scores from these 2 tools decision making became easy.
Conclusions: Objectivity can be employed for making decisions whether to SvA a diabetic foot wound using the WS & GS tools. Information from these 2 scoring tools provides cost justification for decisions regarding patient management of diabetic foot ulcers.