Case 134: An Example of Failure: Patient Discouraged by Lack of Benefit within a Few Weeks Submits to Beneath-the-Knee Amputation.

At age 53, this active smoker had had diabetes for thirty years. He was referred by his vascular surgeon with the lesions shown below. His arteriograms showed that his recent femoral-peroneal and femoral tibial bypasses were occluded.

The calf incision site had necrosed.

He had a necrotic ulcer over his lateral malleolus but most of the skin on the foot was intact and healthy.

He received Long-Boot therapies from his groin to his mid-foot for 17 days as an outpatient. He and his surgeon saw little improvement in his lesions leading him to discontinue the therapy. He subsequently was readmitted to the hospital and underwent a beneath-the-knee amputation..

Comments: This man can be compared with cases 30 and 73. They too had large calf lesions but in addition had more breakdown in the foot and additional risk due to older age. They were healed and this man was not. They were not active smokers. They were determined not to lose their legs. They were able to pursue long courses of therapy. They did not have a doubting vascular surgeon reviewing their course on a weekly basis. Booting is not a cure for all patients. Even if he had undergone our most aggressive therapy (four or more treatments daily until clearly improved), this patient might have lost his leg.