Endovascular Revascularization: A Limb Salvage Strategy After Lower Extremity Burns

Wound complications and amputations are common after lower extremity burn injury in patients with diabetes mellitus (DM). Endovascular revascularization has the potential to promote wound healing and limb salvage in this patient population but has yet to be evaluated. This study describes a burn center's experience incorporating endovascular revascularization into the acute management of lower extremity burns.

Patients admitted to a regional burn center from August 2021 to August 2023 with a lower extremity burn, DM, and an abnormal pulse or noninvasive vascular exam who then underwent diagnostic angiography with or without endovascular revascularization were included in this review. Intraoperative findings and outcomes related to wound healing and amputations were recorded. Significant graft loss was defined as more than 50% surface area loss, prolonged wound care, or need for reoperation following autografting. Digit or transmetatarsal amputations were considered minor amputations. Below or above the knee amputations were considered major amputations.

Of the 23 patients included, there were 29 burn wounds and 32 lower extremities evaluated by angiography. Flow-limiting disease was identified in 16.9% of vessels. Vessel run off to the foot significantly improved postintervention to 2 vessels (2.0-3.0) from one vessel (1.0-2.3, P = 0.0025). After revascularization, 40% of wounds healed without operative intervention and 30% required autografting, of which none had significant graft loss. Major amputations occurred in 30% of cases secondary to infection.

Lower extremity angiography identified flow-limiting, peripheral artery disease often in this cohort of burn-injured patients with DM. In patients who underwent endovascular revascularization, there was no significant graft loss and a 70% limb salvage rate. Endovascular revascularization has the potential to improve outcomes in burn-injured patients with DM and associated peripheral artery disease, but prospective studies are needed.