Case Study

 

Episode of Care:

Diagnoses: Arterial insufficiency; Gangrene right foot; Dementia

Medical History: Left below the knee amputation

PT Start Date: 8/31/2016

PT End Date: 10/28/2016

Number of PT Visits: 24

Initial Evaluation:

Status:

1. 1.  family had opted not to follow the advice of his vascular surgeon for a below knee amputation of his right leg to stop the progression of gangrene. 

   2.  the patient previously had a below the knee amputation of his left leg due to circulatory insufficiency

Prognosis: 

1. 1.  extremely poor based upon his history and present status

   2.  best practices wound care would not stop the gangrenous progression

   3.  septicemia and death

Treatment Plan:

1.  his primary care nurse practitioner opted to try a physical therapy  intervention which incorporated the Treadwell System

Result(s):

1.  signs of progress within the second week

   1.  edema reduction

   2.  discoloration improved

   3.  Induration lessened

   4.  improved range of motion of right ankle and toes 

   5.  observable healing at the gangrenous site

2.  healing was continuous and progressive

3.  odor from the patient’s distal 3rd toe (gangrenous segment) prompted another referral to the vascular surgeon, who no longer recommended surgery

4.  spontaneous amputation of the distal two phalanges of the right 3rd toe occurred

5.  circulation in his right lower leg and foot had returned to normal including healing of his right 3rd toe

Addendum: I have seen this patient in the facility recently, which is 9 months after this episode of care, and his right  lower leg and foot still appear normal with respect to swelling, coloration and induration.

Conclusion(s): In my professional opinion, had the episode of care utilizing the Treadwell System not been engaged, progression of the gangrenous infection would likely have led to sepsis and death.

Estimates of the cost of a below the knee amputation surgery  and subsequent medical interventions begin at $100,000. Had this occurred and the patient survived, he would have had to go to a (more expensive) skilled facility to receive the level of care required for a bilateral amputee.

The total cost of the episode of care delivered utilizing Treadwell technology, which was delivered at the facility (no transportation required for the patient to go to an outside facility for treatments) was approximately $3,000, 3% or less of what the surgical alternative would have cost the healthcare system.

 

Richard Hand, PT