Specialists must work together to prevent leg amputations, urge experts

By Sam Wong
Specialists must work together to prevent leg amputations, urge experts
People with diabetes have a high risk of foot ulcers

A lack of cooperation between doctors is allowing the number of leg amputations to remain high, despite major advances in treatment, warn experts from Imperial College London at an international symposium at the College today. Researchers will highlight the need for early referral and interdisciplinary management at the CX Symposium, which is attended by 3,500 specialists in vascular medicine from across the world.

Around 100 major – at the ankle or above – are performed in England each week. Most of these amputations occur because a foot ulcer has failed to heal. Evidence suggests that the vast majority of amputations could be prevented if patients with ulcers are referred to specialists earlier.

Professor Roger Greenhalgh, from the Department of Surgery and Cancer at Imperial, is programme director of the CX Symposium, which is in its 34th year. He has also set up an initiative called ilegx, which aims to alert health care professionals to the need for interdisciplinary management of foot ulcers.

“Even though we’re making great strides in treatments to improve blood flow to the legs, far too many people still lose their legs, and most of the time it could have been avoided,” he said.

“The solution is very simple: if systematically refer patients early on for specialist treatment, and work together across different disciplines, this would prevent the vast majority of amputations. Unfortunately, there are financial pressures in the health system that discourage doctors from referring patients to other specialists and referring them early, but in reality the cost of having an amputation is much greater. I hope to convince the specialists at our symposium that they can’t do everything themselves – they need to work together with other disciplines.”

Around half of amputations are in people with diabetes, who have a high risk of foot ulcers. The charities Diabetes UK, the Circulation Foundation and the Limbless Association are joining researchers in urging doctors from different disciplines to work together to address the problem.

Barbara Young, Chief Executive of Diabetes UK, said: “I’m really pleased to be speaking at the CX Symposium. Vascular surgeons can play a pivotal role in the prevention of major amputations and that is why I am so glad to have the chance to highlight our ‘Putting Feet First’ campaign to this important audience. “We want to see an end to the postcode lottery of foot care by ensuring that every area has a specialist diabetes foot care team, including a vascular surgeon, and that people with foot ulcers are referred to one of these teams within 24 hours. By working together with vascular surgeons to make this a reality, we can help to bring an end to the national disgrace of preventable amputations."

Professor Gerard Stansby, from the Circulation Foundation, said: “The Circulation Foundation is working hard to fund research into reducing unnecessary limb amputation due to vascular disease. We are delighted to be collaborating with ilegx and Diabetes UK on this venture.”

Graham Facey, Chairman of the Limbless Association, said: "As the leading charity dealing with the limb loss community within the UK we feel it is our obligation to be at the forefront of the fight to prevent amputation if possible and to accomplish this we welcome being involved in this conference to learn so we may pass on the latest information to our members."

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