Every 20 seconds, someone around the worldloses a leg by amputation. Usually the result of diabetes according to George Anosof Valley Presbyterian Van Nuys. Their Amputation Prevention Center featuresa team of medical s devoted entirely to limb saving procedures. In our center,if a patient comesand they've got a sore on their foot which is usually what happenswith a diabetic, it starts with a sore and it doesn't heal and I need a podiatrist, Igo to the door and I say, would you have Belczyk or Rogers come down the hall,would you have the vascular tech come over here, we're going to do vascular studies,we need Xrays, we need a diabetic ,
would you get the diabetes here,would you get my infectious disease guy, and they're all there. Anos discusses theCenter's unique qualities. We have our own vascular lab, we have Xray, we have specializeddiagnostic testing, we have nurses and other s who do particular kinds of woundessings and casts, one stop. But it's focused on the disease and the patient, it's not focusedon what we do it's what they need. It's an approach that's not new for cancer, we allaccept it for cancer and yet if you think about diabetes, diabetes takes way more livesthan cancer. Anos told us about his medical staff. Well we have 2 vascular surgeonswe have full time. We have 2 full time diabetic
podiatrists, these are podiatrists who'vecompleted their training and then gone on to take specialized trainingdiabetic podiatryand then have gone on usually to take additional training after that and each of them werein practice before they came here so these are though they're young, they're highly experiencedwith a whole variety of specialized techniques that are particularly apropos to diabeticfoot problems. Monitoring the patients is one aspect of care. We follow our data. Wefollow every patient completely from beginning to end. Everytime you comewe take a pictureof your ulcer and if it's not getting better, we can back 6 weeks and say, oh you are better,take a look or you're not better, we have
to change course here. And now that's prettyunique and our center is unique. If you take the patients who've come into our center,we save 96% of the people who are facing amputation and if you ask the patient what their chancesof saving their leg, the chance is when they first come in, what is their chance, theysay, oh 95% chance I'm going to lose my leg and they don't know it's just the opposite.It's just the opposite if you bring the important elements to bear, we save 95% percent of thepatients. Anos discusses the Amputation Prevention Center's policy. Our policy is,even if you don't walkyou're going to walk out. We make demands of our patients.We make a major commitment to these people
and we ask them to commit too. We have aroundthe corner from our center is our rehabilitation center and we work closely with them so thatjust because we fixed their leg doesn't mean they're ready for life so they go to the rehabcenter and I tell them when they comeyou may not walkbut you're going to walk out.So we have shorter than average stays, amputation prevention and wound healing andthat's because of the team and that's how we do it and anybody will try someone willtry to find the secret sauce, no secret sauce: team, that's the secret sauce and a team thatcan work together and fortunately we've got terrific people and most of our patients docome from elsewhere and over half of them
have had an attempt at limb salvage beforethey come. More than half and most of them come to us saying, we'll you're the last resortI'm going to lose my leg, what do I have to lose and I tell them, you have your leg tolose and you have a lot to gain.
Leg ulcers are common approximately 2%of adults will have a leg ulcer at some stagetheir lives. Literally thousands of peopledevelop a leg ulcer each yearthe United Kingdom and many of those get more leg ulcersas the years go by. Despite the misery they cause, leg ulcers remain a neglected problem.I am going to tell you the 7 essential facts should you know about leg ulcers. Number 1 What is an ulcer? The medical definition of an ulcer is a breakthe epithelium ofa body surface or lining. Many of us will be familiar with a mouth ulcer. This is abreakthe cell lining the mouth. It can be caused by an injury such as biting theinside of the mouth by accident. Well if the
skin breaks down anywhere on the body it iscalled an ulcer. If the ulcer is on the leg and has been present for more than 6 weeksit is called a chronic leg ulcer. Number 2 What causes a leg ulcer? Four out of 5 ulcers that's 80% are caused by a problem with the leg vein pump and they are called venousulcers. The leg vein pump is the mechanism by which blood flows out of the leg back tothe heart. So problems with the deep veins such as obstruction from a deep vein thrombosis,superficial vein reflux or perforator vein problems can cause venous leg ulcers. Theleg vein pump depends mainly on good ankle movement, good calf muscles and healthy legveins. A minority of leg ulcers about 15%
are caused by problemsthe arteries thatcarry blood into the leg. About 95% of venous leg ulcers can be correctly identified bytheir appearance, by checking for pulsesthe feet and by checking sensation. As mostleg ulcers are venous that's what I am going to concentrate on. Number 3 Whereon the leg do you get venous ulcers? Well venous leg ulcers appear on the lower partof the leg usually just about the ankle. Often, there are varicose veins or thread veins aroundthe ulcer and the leg is usually swollen. The skin is often thickened and discolouredby varicose eczema which many actually develop many months or years before the ulcer as awarning sign that the vein circulation is
not normal. Number 4 Who gets a venousulcer? Well these ulcers affect people who have deep vein problems, usually from a pastdeep vein thrombosis (DVT), people who have superficial venous disease or those with anklemobility problems. Leg ulcers are more common as we get older. Number 5 How do you treatvenous ulcers? The aim of treatment is to get the ulcer healed as quickly as possible.This usually means graduated compression either with bandages or compression stockings. Inmost cases, antibiotics, creams and ointments are not necessary. Once the ulcer is healedit is very important to identify any problems with the superficial veins or perforator veinsand that these are treated to reduce the risk
of another ulcer. This means getting a fullassessment with a duplex ultrasound scan. Number 6 Can you cure a leg ulcer? Well thisis controversial. Some would say that if the problem is onlythe superficial veins,the veins under the skin, orthe perforator veins that connect these superficial veinsto the deep veins, then the ulcer can be cured. While there is good evidence that such treatmentwill greatly reduce the risks of getting another leg ulcer, if the skin has been very damagedand the ulcer has healed with a lot of scarring, this area of the leg may remain vulnerableand a trivial knock or injury might cause another skin breakdown even though the veinabnormality has been completely eradied.
Number 7 How can we avoid leg ulcers? Wellthere are 3 things I would suggest. Firstly, if you are unfortunate enough to suffer adeep vein thrombosis (DVT), it should be treated promptly to limit the damage to the deep veins.Unfortunately, damage to the deep veins cannot be reliably reversed by surgery. So, prompttreatment with anticoagulants blood thinning mediion reduces the extent of the clotand the damage to the deep veins. Secondly, if you have had a DVT, you should considerwearing good quality medical grade compression socks some studies suggest that doing somay reduce the risk of leg ulcers after a big DVT. Thirdly, if you have superficialvein reflux have it treated early to reduce