Peripheral nerve section as palliation for severe ischemic foot pain

Area of Science:

• Vascular Surgery
• Neurology
• Podiatry

Background:

• Elderly patients with severe limb ischemia often present with non-healing lesions or gangrene.
• These patients are frequently unsuitable for conventional vascular reconstructive surgery or minor amputations.
• Major amputation is often the only remaining treatment option for limb salvage.

Purpose of the Study:

• To evaluate the efficacy of multisensory peripheral nerve divisions in elderly patients with severe limb ischemia.
• To assess pain relief and functional limb preservation following the procedure.

Main Methods:

• Seventeen elderly patients (mean age 73) with severe ischemia and forefoot complications underwent peripheral nerve divisions.
• Patients were ineligible for vascular reconstruction or local amputation.
• Outcomes regarding pain relief and limb function were monitored.

Main Results:

• All patients experienced considerable pain relief after the nerve division procedure.
• Only five patients (29%) retained a functional lower extremity for over six months.
• Of the five, one was diabetic and four were non-diabetic.

Conclusions:

• Peripheral nerve section can be a valuable palliative procedure for severe limb ischemia, primarily for pain management.
• The procedure should be applied selectively, with caution in diabetic patients due to poorer functional outcomes.
• Long-term limb function preservation is limited, suggesting careful patient selection is crucial.