At first, Norma Mitchell didn’t think too much about the blister near her toe. But when the sore didn’t heal, she grew worried. After visits to two different urgent care sites, the 71-year-old finally saw her family doctor, who referred her to podiatrist Jessica Sciulli, DPM, medical director at UPMC McKeesport’s Wound Healing Services and chief of podiatry.
Dr. Sciulli immediately suspected poor circulation was the cause. A doppler confirmed Norma had peripheral artery disease (PAD), a circulatory problem in which narrowed arteries reduce blood flow to the limbs — usually the lower legs and feet. A nonhealing wound can develop gangrene, a potentially life-threatening condition when body tissue dies.
“When you don’t have good circulation, any pressure or rubbing in a shoe can quickly turn into a nightmare,” says Dr. Sciulli.
Limb Preservation Program
When gangrene develops in patients with severe PAD, or ischemia, sometimes amputation of the lower leg is the only option. But Dr. Sciulli was determined to do everything possible to heal Norma’s wound.
She called in Lindsey Haga, MD, chief of vascular surgery at UPMC McKeesport. The two are co-directors of the Limb Preservation Program, which is part of UPMC Wound Healing Services. The two doctors work together to quickly evaluate and treat patients with nonhealing wounds.
“Delays result in larger wounds and more problems. The earlier the treatment, the better the chances of saving limbs,” says Dr. Haga.
She explains that without proper blood flow, the body is unable to heal small cuts or breaks in the skin. There is a greater chance of infection because the body’s immune cells can’t reach the wound to fight bacteria. Antibiotics can’t get there either to fight off the infection.
The Limb Preservation Program’s multidisciplinary approach involves specialists in vascular surgery, podiatry, general surgery, infectious diseases, and plastic surgery. The program helps patients gain access to the experts they need without long delays.
“Almost all wounds on the lower extremities benefit from a team approach. Having multiple eyes on the wounds from different areas of medical expertise gives patients the optimal chance of saving limbs,” says Dr. Haga.
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A Limb Saving Procedure
While the initial sore on Norma’s foot was finally resolved, another developed on her toe that turned gangrenous. But the toe could not be amputated because the area couldn’t heal without proper blood flow.
“Norma was in real trouble,” says Dr. Haga. “She was at risk of losing her leg.”
Dr. Haga initially performed an angiogram in hopes that she would then be able to do an angioplasty procedure to open the vessel with a balloon and stent, but the artery was too small. Instead, she restored blood flow to Norma’s lower leg in a complex bypass procedure, using a vein from her thigh to reroute blood flow from the knee to the ankle.
After the bypass, Dr. Sciulli was able to amputate the dead toe. She also was able to debride, or remove, damaged tissue — another key step in wound healing.
“I was so worried, but they saved my leg,” says Norma. “It took a team, and I’m so grateful.”
Continued Follow Up and Care
Norma’s care did not end with surgery. Because she has an aggressive form of vascular disease, she remains at risk of developing sores in both feet. Both Dr. Haga and Dr. Sciulli continue to monitor her to ensure proper blood flow and wound care.
Several months following bypass surgery, the Elizabeth, Pa., resident began experiencing pain in her other leg. An ultrasound showed narrowing of the artery in her other ankle. This time, Dr. Haga cleared the artery in a balloon angioplasty procedure and cleaned out the artery in her groin.
“Together, we are closely monitoring Norma,” says Dr. Haga. “If she needs an intervention to keep the arteries open, we’ll talk to her and work together to address it.”
That suits Norma just fine. “They’ve got my back,” she says. “If I have a problem, I know they’ll take care of me.”
A One-Stop Shop
The Limb Preservation Program at UPMC McKeesport offers a comprehensive approach to wound care and limb preservation. The multidisciplinary team includes specialists in podiatry, vascular surgery, general surgery, infectious diseases, and plastic surgery.
- Vascular testing, studies, and intervention
- Hyperbaric oxygen therapy
- Antibiotic management
- Bioengineered skin substitutes
- Complex reconstruction
- Endovascular repair
- Negative pressure wound therapy
- Targeted wound care
Are You at Risk?
Common peripheral artery disease symptoms:
- Leg pain (cramping) while walking
- Leg numbness or weakness
- Foot or toe wounds that won’t heal or heal slowly
- Gangrene or dead tissue
- No pulse or weak pulse in legs or feet
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Headquartered in Pittsburgh, UPMC is a world-renowned health care provider and insurer. We operate 40 hospitals and 700 doctors’ offices and outpatient centers, with locations in central and western Pennsylvania, Maryland, New York, and internationally. We employ 4,900 physicians, and we are leaders in clinical care, groundbreaking research, and treatment breakthroughs. U.S. News & World Report consistently ranks UPMC Presbyterian Shadyside as one of the nation’s best hospitals in many specialties and ranks UPMC Children’s Hospital of Pittsburgh on its Honor Roll of America’s Best Children’s Hospitals.