Limb Preservation and Wound-Healing Treatments for People with Diabetes

Richard F. Neville, MD, is Associate Director of the Inova Heart and Vascular Institute and Chairman of the Department of Surgery at Inova. He also serves as Co-Director of the Limb Preservation Program. He is board certified in vascular surgery and is a distinguished fellow of the Society for Vascular Surgery.

People with diabetes face a number of potential health complications, especially related to blood circulation and their feet. Many people with diabetes also have peripheral artery disease (PAD), which restricts blood flow to the limbs, as well as neuropathy (nerve damage) that causes limb numbness, weakness or pain. These conditions make it more likely that a person will develop wounds and infections that affect the legs and feet.

These diabetic complications are one of the most significant risk factors that can lead to amputation when not well managed. In fact, about 60 percent of all nontraumatic lower limb amputations are related to diabetes. Not only does limb loss significantly affect daily life, but it can also increase the risk of additional health problems and may even decrease lifespan.

Thankfully, estimates show that about 85 percent of all diabetes-related amputations can be prevented with early intervention and specialized treatment. At Inova Health System, those at risk of limb loss  have access to comprehensive, highly specialized care through Inova’s vascular surgeons and the Inova Wound Healing Centers. 

If you have diabetes and see a red spot or open wound on your legs or feet, it’s important to schedule an appointment with your primary care provider as soon as possible. Your primary care provider can run comprehensive tests to screen for conditions like PAD or neuropathy. They can also refer you to a wound specialist who can help you start on a path to healing.

What to Expect at the Inova Wound Healing Centers

During your initial consultation with our wound healing team, we complete a comprehensive evaluation to assess every factor that may affect wound healing. We review your most recent lab tests or order new ones if needed. We may also order vascular studies, X-rays or MRIs to further understand what’s going on inside your body that is contributing to your nonhealing wounds.

The assessment includes a thorough examination of your lower extremities. We check for areas of tissue changes, swelling or sores. We examine the wound itself and start identifying effective treatments.

If you appear to have an infection, we take a small sample of tissue or fluid for a wound culture to identify what bacteria or fungus may have caused the infection. We clean out the wound with a specialized machine that minimizes pain. Your specialist will likely prescribe an antibiotic and start a topical antimicrobial dressing, a treatment where we apply infection-fighting antiseptics to your skin.

Wound Care and Limb Preservation Treatments

The Inova Wound Healing Centers are staffed by a team of clinicians with advanced training in wound management who work closely with Inova’s vascular surgeons. Our collaborative approach starts you on the path to healing the same day as your initial evaluation.

Our four locations across Northern Virginia offer convenient access to a full spectrum of specialized treatments to help you heal and lower your risk of complications including:

• Compression stockings to reduce swelling
• Specialized shoes to accommodate structural foot problems
• Advanced wound dressings including topical antimicrobial treatments to heal damaged tissue
• Wound grafts made of synthetic materials or skin substitutes 
• Negative pressure wound therapy, using wound dressings that apply pressure to draw fluid and infection out of a wound
• Hyperbaric oxygen therapy, which involves sitting in a pressurized chamber and breathing in pure oxygen to promote faster healing
• Autologous platelet therapy, which involves injecting a concentration of your own blood platelets into the wound to accelerate healing  
• Prosthetics and rehabilitation services for patients who need an amputation

After your initial visit, we typically see you for a follow-up appointment within one week, or sooner if you have an infection. After your infection heals or your wound closes, you see our specialists on an ongoing basis, as needed, to lower your risk of future infections.

Limb Preservation

If you have a high risk of losing a limb, you are seen at the Inova Vascular – Fairfax office, located in the Inova Specialty Center, for a comprehensive assessment. Our vascular surgeons evaluate whether you could benefit from a vascular or endovascular (minimally invasive) procedure to restore blood flow to your limbs.

The complexity and nature of the underlying disease determine whether you return for follow-up visits at the Inova Vascular – Fairfax office or at one of our four Inova Wound Healing Centers. Most patients require weekly or biweekly follow-up visits.

You may return to the Inova Vascular – Fairfax location for remission visits every two, three or six months. Remission visits continue for patients whose condition has stabilized but who remain at risk of limb loss.

Advanced Diabetes Wound Care

Our team discusses care plans daily, coordinating any necessary referrals or follow-up tests quickly to make sure you experience no gaps in care. We ensure you receive testing results and any other follow-up information in a timely manner.. 

We also offer expanded access to care through telehealth visits. Collaborating with home health nurses allows us to complete even more virtual visits, providing several services typically only offered in the office, such as wound cultures.

Inova’s team continues to advance the field of wound care and limb preservation with ongoing research efforts. Our doctors have partnered with the American Diabetes Association as members of the Amputation Prevention Alliance, an initiative to prevent amputation in people with diabetes. Together, we are moving the field forward to continue providing you with the very best care.

Learn more about the Inova Wound Healing Centers or request an appointment at a location near you.

Learn more about our Comprehensive vascular services.

Inova Wound Healing Center Locations:

• Dorothea R. Fisher Wound Healing Center at Inova Mount Vernon Hospital, 2501 Parkers Lane, Alexandria, VA 22306
• Inova Wound Healing Center – Fair Oaks, 3700 Joseph Siewick Dr., #105, Fairfax, VA 22033
• Inova Wound Healing Center – Fairfax, 3299 Woodburn Rd, #180, Annandale, VA 22003
• Inova Wound Healing Center – Lansdowne, 44055 Riverside Parkway, #150, Leesburg, VA 20176