New Outpatient Limb Preservation Service Offers Comprehensive Access to Specialists

Losing a limb — a devastating event for anyone — is far more likely in patients with diabetes, peripheral artery disease or other complex conditions that impair circulation to the legs. But preventing that bleak outcome is the mission of University of Maryland Medical Center's (UMMC) recently opened Outpatient Limb Preservation Clinic, which fuses the talents of several types of specialists to evaluate and provide comprehensive treatment plans to patients in a single visit.

The clinic, held on Friday afternoons, is expected to draw about 250 patients each year at risk of losing a limb, a life-changing situation that, particularly in the elderly, often results in the loss of independence.

Nearly all lower limb amputations begin with a non-healing ulcer or chronic wound in the foot, according to Rajabrata Sarkar, M.D., Ph.D., chief of the division of vascular surgery at UMMC and a professor of surgery at University of Maryland School of Medicine. Drs. Areck Ucuzian, MD, PhD, an assistant professor of surgery, and Jacob Wynes, DPM, a faculty member of orthopaedics, serve as co-directors of the clinic with Dr. Sarkar.

Additionally, more than 60% of all lower limb amputations are performed in people with diabetes, according to the American Diabetes Association.

"We developed this clinic as a means of focusing the care of patients that may be seen in different specialties in whom prompt evaluation and treatment is often delayed," Dr. Sarkar explains. "This was prompted by the fact that we unfortunately see many patients with advanced gangrene or severe ischemia — inadequate blood supply — that required amputation in which we thought an earlier comprehensive evaluation might have possibly saved the limb.

"We conceived this clinic as a means of allowing patients, family members and doctors to identify a single point of care that initiates treatment," he adds.

Bevy of Treatments Can Heal Wounds, Restore Blood Flow

In one visit, patients meet with UMMC specialists in podiatry, vascular surgery and infectious disease. The focus is on painless, non-invasive diagnostic methods, such as ultrasound and x-rays, to determine the location and scope of impaired blood flow to the leg, as well as any bony infection or abnormality. This process enables physicians to devise individualized treatment plans that may involve medical or surgical approaches, including medications; circulatory assist devices; specialized wound care products; and both minimally invasive and open surgical procedures.

Hyperbaric treatment, believed to facilitate the growth of new blood vessels, is also available. Additionally, consultations with specialists in plastic surgery, vascular medicine and cardiology are available when needed.

"Roughly two-thirds of patients we see need procedures to improve blood flow to the foot," Dr. Sarkar says. "We provide one-stop shopping for patients from experienced specialists who are comfortable planning and performing complex operations together."

Location Boosts Under-served Population

Located in West Baltimore, the clinic operates in a traditionally underserved area where access to health care can be a challenge, Dr. Sarkar says. That makes its recent establishment especially compelling.

"We want this program to be a single point of contact where a patient, family member, referring doctor or wound care nurse can pick up the phone and say, 'I think this patient has a serious problem. This wound doesn't look right to me,' and the patient will be comprehensively evaluated by a team of experts," Dr. Sarkar says. "Outpatient care of leg ulcers and peripheral artery disease is often fragmented, and this allows us to get patients evaluated and treated in a program that's going to aggressively get their ulcer healed."

UMMC's Outpatient Limb Preservation Clinic is located at 419 Redwood, Suite 300. For more information, please call 410-328-5840.