In the past we often considered minor or major amputations
in ischemic legs of young smokers when the medical and surgical therapies
failed to relieve the severe pain associated with non healing ulcers or
gangrene. But now after the introduction of Prostaglandin E-1 infusions
therapies for the below knee non re-constructable vascular disease we are able
to relieve the rest pain and help in healing the ischemic ulcers with more
certainty. We are following the patients for 6 months and so we are able to guide
the patients and confirm their limb salvage for a long time. The cost of
therapies has also been spread over a period of 6 months and so their
affordability and compliance is surprisingly very good in these ill nourished
patients. We have also been looking for features of systemic inflammatory
responses (SIRS) in these patients who are groaning with ischemic rest pain.
Low dose steroid therapy and immune modulators have been helpful in TAO
patients with SIRS like features when added to the PGE-1 therapy. We did not
use epidural analgesia for the relief of rest pain in the recent past when we
are using the PGE1 + LDS + IMT. We do not routinely consider the wound swab
cultures from the ulcers or dry gangrene with minimal wetting of the surface.
These patients do not tolerate dressing over their feet and they loosely wrap
gauze bandage over their ischemic ulcers, gangrene feet. Few patients are not
able to abstain from smoking though they may reduce the number of cigarettes.
Yet, we have noted the good response with the PGE1 + LDS + IMT in these people.
We have not done major amputations in the last year in these patients. Only
gangrenous toes which are failing to separate and fall off, on the request of
the patients we consider surgical separation after completion of the PGE1 + LDS
+ IMT course.
