Seamless Transitions: An Illustration Of A Successful Team-Based Approach To Limb Salvage Care

Venous lower extremity pathology is a common but complex problem taking a toll on patients and the healthcare system. Standard treatment protocols for venous lower extremity pathology are accepted, however which providers should assume care is not clearly defined. Each discipline in limb salvage teams plays an important role and is necessary for successful outcomes.This case illustrates a 52-year-old woman with complex lower extremity venous insufficiency and gangrene, admitted from wound clinic in June 2020 for serial debridements. The patient had severe venous edema incompatible with successful immediate grafting outcomes. She was transferred to a Long Term Acute Care hospital (LTACH) in July for aggressive wound care with Negative Pressure Wound Therapy (NPWT), ultrasonic debridements, diuresis, and compression for edema control until the wound was fully granulated. In August, she received a split-thickness skin graft by a wound medicine-certified plastic surgeon in which NPWT and progressive three-to-five-layer compression was applied. She was transferred postoperatively back to the LTACH with treatment of NPWT and edema control to allow successful graft take. The patient followed up in outpatient wound clinic to achieve total healing. It should be noted that the same wound and limb salvage team was involved in each care setting, with seamless communication between providers for successful transitions.While the standard protocol of patient optimization, wound debridement, split-thickness skin grafting, and postoperative care to provide final wound healing is customary for managing chronic lower extremity venous wounds, this case highlights the essential intricacy in care coordination. Having a comprehensive and united limb salvage team at multiple care sites who trust one another to work in this coordinated and sequential team approach helps accomplish limb salvage for complex cases. While the standards of care for wound management evolve, the united multidisciplinary team is one factor that should remain consistent.