Limb Salvage; A case report

Acute limb ischemia is a sudden decrease in limb perfusion that threatens limb viability, usually due to acute arterial occlusion. Acute arterial occlusion is most commonly related to thrombosis of a diseased but previously patent, often atherosclerotic artery.

84 year old female admitted for emergency thrombectomy with acute thrombus of the left common femoral artery. She received platelets and FFP due to post procedure bleeding and developed a contusion to the calf. She was discharged to rehab facility returning one month later with UTI and large left calf wound. Moist wound care was continued.  Six weeks later she was readmitted with septic shock, large gangrenous left calf wound and necrotic left heel. Patient was at high risk for amputation of the leg. Multi-disciplinary meeting was held with patient’s daughter (primary caretaker) to discuss treatment plan including amputation which the daughter refused. HBOT was initiated, multi focal atherectomy done and wound care continued. Patient received 6 HBOT treatments before discharge to rehab facility. She was followed at the Wound Center. The wounds were debrided and a VAC placed.  A few weeks later a fish skin graft was placed to the calf wound 3 times.

The left heel wound resolved and in 4 months the left posterior leg wound decreased 70 % in size. A petrolatum dressing was placed. As per daughter she was receiving PT and had taken a few steps.

Multi-disciplinary approach and use of new and adjunctive modalities resulted in limb salvage. HBOT raised the vascular bed in preparation for graft. Omega 3 fish skin is a new skin substitute rich in naturally occurring Omega 3 polyunsaturated fatty acids from wild Icelandic Cod. The fish skin has the same structure as human skin. Unfortunately the patient contracted COVID 19 during the pandemic and succumbed to the virus.

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