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More than 2 million Americans are living with limb loss, and that number is expected to grow as the population ages. UT Health San Antonio has a program designed to expand treatment options for those patients.
The Limb Optimization Program has been serving patients for the past 14 months, bringing together specialists who treat patients at risk of limb loss from traumatic injuries — including combat wounds suffered by veterans — as well as cancer and congenital conditions. Doctors say the goal is to preserve a patient's limb whenever possible and, when that's not an option, provide the most advanced reconstructive solutions available.
One of those solutions is a procedure called osseointegration, which anchors a prosthetic directly to a patient's remaining bone rather than relying on a traditional socket.
Dr. Joseph Alderete is an orthopedic oncologist with UT Health San Antonio.
“And this is bone-anchored limb, or basically the ability to create a skeletal anchor, so that an amputee doesn't have to use a socket anymore,” said Alderete “They can just basically Lego off, Lego on. I have patients that use different legs for, let's say, open water diving, or getting around the medical center versus something that helps them with uneven terrain.”
Alderete said the technology, which is the first of its kind in South Texas, gives patients more flexibility and can improve their quality of life. He said his team provides limb salvage procedures.
“We can bring nerve, artery, multiple veins, muscle, bone, and skin to a defect that was either again created by roadside bomb or that I have to generate in alleviating a patient of cancer,” said Alderete.
Alderete said whether a patient is trying to save a limb or coping with its loss, the experience can be physically and emotionally difficult.
“Because in many cases when you bite off on limb salvage, the road can lead to divorce, (or you could become) destitute and dependent on narcotics, because it’s operation, operation, operation. (Spend) time in the hospital, (experience) setback, and then win, and then setback. ... We can look at the finish line and look back at where we were and say, ‘Wow, you know, we really got someplace amazing.’ But like, you can get punched in the face multiple times along the pathway. Likewise, an amputation is not one-and-done,” said Alderete.
Alderete said the Limb Optimization Program includes a psychological screening process that evaluates patients throughout their recovery.
"One, are we reasonably understanding of the problem and of the goals ahead? In some cases, patients will come to me horribly frustrated, addicted to narcotics, in some cases using maladaptive substances to medicate their pain and their frustration, and it's fine. I do not dogmatically say, ‘Well, you're not for the program,’" said Alderete
Alderete’s team uses ultra-low dose ketamine therapy in extremely large limb reconstruction due to tumor or trauma, as well as in an advanced amputee neuropathic pain pathway.
“We facilitate this therapy with the help of the medicine and surgery critical care unit at University Hospital. This is the first-of-its-kind in an orthopedic surgeon-led pathway because this is typically facilitated by the anesthesia pain team," said Alderete.
"However, in this case, our relationship with our patients necessitates a better alternative to narcotic therapy, which addresses both the anxiety, components of pain, as well as typical pain receptors and an NMDA and BDNF, any depressant effect. These effects in mood elevation can be so profound they can last weeks,” said Alderete. "This facilitates better participation in therapy, better mood, and the obvious advantage of discharging patients, even after massive amputation or spinal pelvic reconstruction, with no narcotics after just three to four days.”
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