The Interventional Institute's Wound Healing and Limb Salvage Program at Holy Name Medical Center is dedicated to the care of patients with non-healing wounds from lower limb peripheral arterial disease (PAD) and the resulting atherosclerosis, or hardening of the arteries. These conditions decrease blood flow-and oxygen-to the lower leg, foot and ankle, resulting in wounds or ulcers that won't heal. If circulation problems persist, critical limb ischemia (CLI) can develop, resulting in leg pain or gangrene, and lower leg amputations may become necessary.
Non-healing wounds caused by impaired circulation will not respond to traditional methods of wound care alone, such as debridement and hyperbaric oxygen therapy, because blood and the oxygen it carries, cannot reach the injured area. But by clearing a path to the wound, effective treatment can take place. Holy Name's Vascular and Interventional Radiologists are using minimally invasive revascularization procedures that can restore circulation and the flow of oxygen, providing the foundation for healthy wound healing.
Holy Name Medical Center is one of the only hospitals in New Jersey with a specialized team of doctors who perform advanced minimally invasive endovascular treatments specifically designed for individuals who may face lower leg amputations due to non-healing wounds.
Under the direction of Dr. John Rundback, an internationally recognized leader in the field of Interventional Radiology, the IR medical team works with experts at wound care centers, vascular surgeons, endocrinologists, podiatrists, and orthopedists to provide treatments that will promote wound-healing among patients with vascular problems. The focus is on preserving lower limbs (toes, feet and ankles) and the ability to walk, and maintaining patients' quality of life.
About Interventional Radiology
Interventional radiology (IR) techniques have been in use for about 30 years, making the specialty a relatively recent development. Further advancements in revascularization during the last two to three years have allowed access to the smallest blood vessels below the knees and into the ankle and foot.
Using imaging for guidance, the interventional radiologist threads a thin catheter through the femoral artery in the groin to the affected artery in the leg. A balloon is inflated to open the blood vessel where it is narrowed or blocked. In some cases, the reopened artery requires an atherectomy (a "rotorooter" to open the artery) and/or a stent (a tiny metal cylinder) This minimally invasive treatment does not require surgery.
When the obstructed artery is cleared, blood flow into the lower extremity is restored, bringing oxygen and allowing the healing process to begin. Holy Name's success rate for limb salvage is as high as 80%, vastly reducing the incidence of amputation and greatly enhancing quality of life.
Causes and Symptoms
Underlying health conditions that can cause non-healing wounds include:
- High blood pressure (hypertension)
- High cholesterol
- Kidney disease
Symptoms of PAD that can result in non-healing wounds can be subtle and hard to detect. Knowing what to look for will help you detect PAD early, and early detection is the key to wound healing and limb salvage. PAD symptoms include:
- Reddish, purplish, or bluish discoloration of the toes or foot
- Numbness, weakness, pain in the legs
- Non-healing wound, ulcers, sores on toes, feet or legs
- Coldness in the feet or legs
- Slow growth of the toenails
- Weak pulse in legs or feet
- Loss of hair on toes or foot
- Thinning of skin
Advanced symptoms of non-healing wounds include:
- Persistent, increased pain in the area of the wound
- Discoloration of the wound near its edges, often a dark or bluish color
- Increased drainage from the wound
- Redness or swelling around or spreading away from the wound
- A foul odor coming from the wound
- Early gangrene (death of tissue)
Diabetic Foot Ulcers
People with diabetes can develop a foot wound without realizing it, due to loss of sensation in the lower limb. The wound only becomes noticeable once it is problematic.
Venous Leg Ulcers
This is a shallow wound that occurs because of damaged veins resulting in venous hypertension and poor return of blood flow to heart.
Usually affecting people who are bedridden or wheelchair-bound, this wound occurs when excess friction injures the skin and underlying tissues.
Prospective patients are first evaluated to determine whether a wound is non-healing due to a vascular problem. The vascular assessment includes a physical exam, basic non-invasive testing procedures, such as arterial Doppler and arterial ultrasound, as well as more advanced testing including CT and/or MR angiography scan, and MRI.
If the patient meets eligibility requirements, a procedure will be scheduled. The procedure is performed in a surgical suite, and the patient may be discharged the same day, or after an overnight stay.