Driving Care When There are Barriers to a Multidisciplinary Approach

In her American Society of Podiatric Surgeons’ annual conference session, “When There is No Multidisciplinary Team,” Vilayvanh Saysoukha, DPM, MSc, FASPS, FACPM, FACFAS, presented her experience with facing this limb preservation challenge head on. She also shared some key highlights and insights with Podiatry Today in this interview.

There has been much discussion on the importance of a multidisciplinary team in limb salvage. However, in what cases might such a construct not be available? 

In rural and critical access regions, a fully developed multidisciplinary limb salvage team is not always available. In these environments, I often take the initiative to lead patient care, relying on sound clinical judgment and evidence-based decision-making. I’m comfortable performing office-based bone debridement when indicated, managing infections with culture-directed therapy, and utilizing skin substitute grafts when appropriate to promote and accelerate healing. My goal is to provide the same quality of care patients would receive at a tertiary center, even when those facilities are an hour or more away. Practicing in these settings has strengthened my ability to adapt, think critically, and take ownership of complex cases to ensure optimal outcomes.

What are some examples of strategies a podiatric surgeon could employ when this is the case?

The primary objective when treating diabetic foot or ischemic infections is source control. In rural settings, we don’t always have the luxury of immediate vascular intervention, so prioritizing infection management becomes essential. I’m fortunate to hold privileges at a higher-level sister hospital, which allows me to continue following my patients if they require transfer for vascular procedures. However, there have been situations where vascular intervention wasn’t initially an option. In those cases, maintaining collaborative relationships with other specialists—such as interventional cardiologists who share a passion for limb salvage—has been invaluable. Establishing those cross-specialty partnerships ensures that patients receive comprehensive, timely care even in resource-limited settings.  

What do you most want podiatric surgeons to know about these types of scenarios?

As podiatric surgeons, we’re inherently our patients’ strongest advocates in preventing major limb amputation. In critical access areas, that advocacy becomes even more vital because we often wear multiple hats. We may need to follow a different clinical decision pathway than colleagues who have immediate access to a full multidisciplinary team. The ability to perform in-office procedures—such as tenotomies, plantar fasciotomies, bone excisions, partial toe amputations, delayed primary closures, and application of skin substitute grafts—allows us to deliver effective limb salvage care close to home. Just as importantly, cultivating strong relationships with vascular specialists, whether vascular surgeons, interventional radiologists, or interventional cardiologists, who are equally committed to limb preservation is key to achieving successful outcomes.  

Dr. Saysoukha practices in Murfreesboro and McMinnville, TN at Premier Foot & Ankle Centers of Tennessee.