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Medical Management of the Limb Salvage Inpatient

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Functional Limb Salvage

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Abstract

Almost by definition, patients requiring limb salvage care are medically complex with multiple comorbidities. We prefer a co-management model of care with an internal medicine hospitalist working in conjunction with the surgical, infectious disease, vascular, and anesthesia teams. This model includes daily morning in-person communication about each hospitalized patient to coordinate care. These complex patients require care coordination with a multidisciplinary approach.

The role of the internist is to identify and manage medical problems in conjunction with the surgical team. Initial evaluation involves comprehensive medical history and examination to identify underlying conditions that may affect surgical outcome such as coronary artery disease, congestive heart failure, cerebrovascular disease, chronic kidney disease, peripheral vascular disease, diabetes, and others. The first priority is an assessment of perioperative cardiac risk. The internist must be adept at performing a preoperative cardiac risk assessment, including knowledge of preoperative testing guidelines and medication management of chronic cardiac conditions. Other major management issues include care for diabetes and anticoagulation management. Diabetes management is complicated by the frequent need for insulin adjustment due to repeated days where the patient is NPO. Anticoagulation management is particularly challenging given the competing priorities of avoiding both thrombotic and bleeding complications in patients with the need for multiple trips to the operating room. Hospital care must include prevention, early detection, and treatment of medical complications including acute kidney injury, delirium, and gastrointestinal complications. These medical issues must be evaluated and treated in coordination with the surgical team to facilitate successful surgical outcomes.

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Authors and Affiliations

  1. Department of Internal Medicine, Medstar Georgetown University Hospital, Washington, DC, USA

    Marie M. Alternburg, Jennifer M. Haydek, Sara Kiparizoska, Nina K. Weaver & Margot G. Wheeler

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  1. Marie M. Alternburg
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  2. Jennifer M. Haydek
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  4. Nina K. Weaver
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  5. Margot G. Wheeler
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Correspondence to Margot G. Wheeler .

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  1. Department of Plastic Surgery, Georgetown University School of Medicine and MedStar Georgetown University Hospital, Washington, DC, USA

    Christopher E. Attinger

  2. Department of Plastic Surgery, Georgetown University School of Medicine and MedStar Georgetown University Hospital, Washington, DC, USA

    John S. Steinberg

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Alternburg, M.M., Haydek, J.M., Kiparizoska, S., Weaver, N.K., Wheeler, M.G. (2023). Medical Management of the Limb Salvage Inpatient. In: Attinger, C.E., Steinberg, J.S. (eds) Functional Limb Salvage. Springer, Cham. https://doi.org/10.1007/978-3-031-27725-2_8

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