Lessening Limb Loss with Interstate Collaboration in Charcot Arthropathy and Osteomyelitis

Introduction: Patients in rural healthcare settings are more likely to lose salvageable limbs due to Charcot arthropathy and chronic osteomy- elitis. These patients often have limited or no access to advanced tech- nology or the specialized physicians who provide such treatments and interventions. Establishing a pathway for underserved areas to receive limb-saving treatment is crucial. Below-knee amputations should not be preferred simply due to limited access to specialists in Charcot recon- struction and osteomyelitis care. Methods: Four Charcot arthropathy and osteomyelitis patients were selected to receive advanced treatment out of state. These treatments included the percutaneous injection of gentamicin-based antibiotic sulfate*, Charcot reconstruction, and external fixation devices. Patients returned to their local wound clinic for post-operative care after the procedures. Their cases were managed collaboratively through telemedi- cine, involving the review of imaging and photographs. Any complications were managed locally and with prompt interprofessional communication between provider and surgeon. *Trade marked- Cerament G Results: Two patients have healed, are walking and have been dis- charged from the wound care clinic, one patient developed proximal com- plications and will unfortunately require below-knee amputation, and one patient has recently returned to the local clinic for post-operative care. One patient required a second trip to the surgical location; the remainder of patients have been managed in the local area. Discussion: It is feasible for patients to undergo complex surgical interventions and then return to their local wound clinic for follow-up care without the need for frequent travel to the surgical location. Pa- tients should be informed of advanced surgery options available outside the area or state. As evidenced here, the assumption that patients are unwilling and/or unable to travel must be challenged. We can and should expand protocols to additional locations using a hub-and-spoke model, which effectively facilitates referrals from wound care clinics to surgical specialists. This innovative approach to wound care referrals demon- strates that limb salvage can be highly achievable when patients actively engage with a dedicated team of wound care professionals and surgeons. Collaboration is key to fostering positive outcomes in the healing process.