1902 - Bilateral Ischemic Phalangeal Salvation in a Bilateral Below-Knee Amputee: An Unconventional Approach

Case Diagnosis: Bilateral Ischemic Phalangeal Salvation in a Bilateral Below-Knee Amputee

Case Description:

53-year-old woman who was hospitalized with septic shock complicated by bilateral hands and feet necrotic ischemia. These limb presentations were unresponsive to pharmacological, wound management, or vascular treatments. With her hands, the vascular surgeon recommended interphalangeal joint amputations, however the patient opted to trial conservative management. She received inpatient HBOT and continued daily home HBOT for 8-10 weeks. She also received daily home PEMF therapy and fascial manipulation. Since then, she has had complete resolution of necrosis, with improved physical appearance, viable and healthy soft tissues, and stronger pulses.

Discussions:

There are unconventional therapeutic approaches for the management of ischemic limbs. Some of these unconventional approaches include fascia manipulation, hyperbaric oxygen therapy, and pulsed electromagnetic field therapy which offer new possibilities for limb salvation.

Fascia manipulation addresses these issues by releasing adhesions which improves arterial stiffness, restoring fluid dynamics which leads to vasodilation of vessels, and improving lymphatic drainage which can decreased the possibility of ulceration.

HBOT addresses non-healing wounds by interrupting inflammatory stasis, controlling infection, enhancing tissue perfusion. HBOT reduces major amputation risk and promotes wound healing in diabetic foot ulcers in selected patients. However, clinical implementation remains limited in HBOT by accessibility concerns

PEMF is a non-invasive, non-thermal treatment utilizing pulsed electromagnetic fields delivered through a micro-generator and antenna. Research demonstrates PEMF's efficacy in accelerating healing of fresh, post-operative, and chronic wounds.

Conclusions:

This case highlights a unique alternative therapeutic approach for patients facing amputation due to ischemia. While this approach may not be suitable for every patient with ischemic limb disease, the combination of fascia manipulation, HBOT, and PEMF successfully preserved limb function in this patient, which could provide options for others where conventional treatments have failed or are contraindicated.