Limb Preservation Program

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[Text on screen: The Ohio State University Wexner Medical Center
Rajiv Chandawarkar, MD
Director of Plastic Surgery at University Hospital East]

Rajiv Chandawarkar, MD: I'm the director of the Limb Preservation Program here at the Ohio State University Wexner Medical Center. Our current focus has been on limb preservation program. Just to give you a background of what this really means, patients who have diabetes have a 25 fold increase in the need for an amputation than a person who doesn't have diabetes. 15% of patients will get an amputation at some point in time. In fact, the international working group on diabetes made this very clear that at any given time globally, there is an amputation going on, on some diabetes related complication every half a minute, every 30 seconds. 

Our goal here at the Limb Preservation Program, which I lead, is to create the team that will help prevent the amputation, provide reconstructive services that are extremely sophisticated, not just in terms of their surgical sophistication, but also in terms of the repertoire of services required to bring these patients back to a functional level that is extremely important for their lives and for their productivity, and also make sure that they're included as part of the team in being able to control these problems.

When we see diabetic patients, either at our main campus or at OSU East, we have a team of people looking at the problem in their own special way in terms of their expertise. We have a podiatrist. We have a foot and ankle doctor. We have vascular surgeons, two of them who will perform complex vascular reconstructions if that is the necessity. We have three plastic surgeons who will perform complex reconstructive plastic surgery on them to prevent an amputation. 

And these involve a plethora of procedures including microvascular surgery, perforator flaps that will provide the right soft tissue coverage for them to prevent limb loss. Last but not the least, we also have infectious disease services that will look at specific antibiotics that they may need going forward. We have orthopedic surgeons who look at the bone requirements. We have endocrinologists on board who look at diabetes care from a more global perspective at making sure that these problems don't recur. We also have the rehab team that looks at what is the functional outcome of what we do. 

It obviously takes a village to do this right. It's easy enough for many centers to do limb preservation in name, but to put together a team that will sing the same tune is a difficult task, and we've been able to accomplish that here at OSU. Our effort has been to involve the patient right from the start. We do this not just from the standpoint of education, but in terms of having them understand the complexity of the problem and the repertoire of services that they're going to receive going forward.

[Text on screen: The Ohio State University Wexner Medical Center]

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