Tulsa Launches Limb Preservation Clinic and Study to Decrease Amputations Preserving Limbs

An OU Health vascular surgery team and a podiatrist in Tulsa have launched efforts to reduce the number of major amputations due to complications from diabetes and peripheral artery disease.

Oklahomans experience high rates of diabetes and peripheral artery disease, which are the primary non-traumatic contributors to leg amputation, said Kelly Kempe, M.D., whose work as a vascular surgeon is to help patients achieve the blood flow necessary to avoid an amputation. Kempe, her vascular surgery partners and her new colleague, podiatrist Todd Hasenstein, DPM, are beginning a Limb Preservation Clinic in Tulsa. In addition, Kempe is collaborating with primary care physicians across Oklahoma to monitor patients who are at risk for amputation.

“Throughout the mid-South and South, there is a disproportionately high rate of major amputations,” Kempe said. “Too many people come to me with non-salvageable limbs, which means they have end-stage disease and there’s nothing I can do to help them avoid an amputation. But it doesn’t have to be this way. There is a lot we can do to screen and monitor patients who are at high risk for an amputation.” Both diabetes and peripheral artery disease, by themselves or in combination, can lead to amputation. With diabetes, people can lose sensation in their feet, which puts them at risk for open wounds they don’t know they have, Kempe said. People without sensation in their feet also get calluses and pressure points that can turn into open wounds, allowing bacteria to enter and cause infection.

“Primary care physicians are on the front lines for patients with these longstanding diseases that can lead to a dramatic change in their overall health.”

If a patient must have a toe amputation, that puts them at much higher risk of a major amputation, which is defined as the leg, above or below the knee.

“That’s why we recommend that people look at the bottom of their feet every day,” Kempe said. “If they’re unable to do that themselves, they can ask a family member or friend to check, or they can place a mirror at a 45-degree angle so they can see their feet.”

In peripheral artery disease – the same condition that causes heart attacks and strokes – the arteries to the legs become narrow or blocked. The more extensive the blockage, the less blood flow to the leg and foot. Patients with this disease also need to check their feet, Kempe said. Much of the medical care for people with diabetes or peripheral artery disease is provided by primary care physicians across Oklahoma. That’s why Kempe is conducting a study that she hopes will shed light on how best practices may need to change for more effective monitoring of patients at risk.

With grant funding from the Society for Vascular Surgery Foundation, she is surveying and interviewing primary care physicians around the state. She is conducting her work through the Oklahoma Primary Healthcare Improvement Cooperative (OPHIC), a program at the OU Health Sciences Center that disseminates evidence-based practices to primary care providers.

“Primary care physicians are on the front lines for patients with these longstanding diseases that can lead to a dramatic change in their overall health,” she said. “We want to get a feel for what barriers physicians face, and what helps them when their patients have at-risk limbs. We also need to know if they have trouble accessing specialty care. Based on what we learn, we want to make a difference for these patients, both in terms of prevention and if they have an urgent need.” The new Limb Preservation Clinic is also a major step forward in preventing amputation. In addition to Kempe and her partners’ expertise in the vascular system, Hasenstein’s skills as a podiatrist are equally important for patients.

“Podiatrists look at different things than I do, such as foot deformities and calluses,” Kempe said. “For example, if a patient has a toe amputation, the podiatrist will know if there needs to be a tendon release. Then it’s my job to make sure the patient’s blood flow is as good as possible.”

Over time, the Limb Preservation Clinic plans to add more specialties to the clinic, including diabetes management and medication management.