Table 4 Conversion of MDT treatment recommendations
Reason for non-implementation | MDT treatment recommendation | Final course of action |
|---|---|---|
Patient’s preference | Implant removal ankle, free flap reconstruction lower leg | Implant removal, conservative wound treatment, shock wave therapy |
Patient’s preference | Lower leg amputation | Conservative wound treatment, negative pressure therapy |
Patient’s preference | Lower leg amputation | Conservative wound treatment |
Patient’s preference | Lower leg amputation | Ilizarov bone transport |
Patient’s preference | Free flap reconstruction, ankle arthrodesis with bone grafting | Free flap reconstruction, simple osteosynthesis |
Patient’s preference | Lower leg amputation | Conservative wound treatment, negative pressure therapy |
Comorbidity (severe PVD) | AV-Loop, free flap reconstruction lower leg | Iliac artery angioplasty, femoral artery angioplasty, PTA A. poplitea, lower leg amputation, prosthesis |
Comorbidity (severe PVD) | Vascular imaging, free flap reconstruction, lower limb amputation | Transfemoral amputation |
New clinical information (insufficient perfused soft tissue and muscles) | Humerus reconstruction by fibular free flap reconstruction, plate osteosynthesis, radial artery reconstruction, fasciocutaneous free flap reconstruction, median nerve reconstruction through sural nerve grafting | Upper limb amputation, prosthesis |
New clinical information (new inguinal wound healing problem) | Femur-removal, lower leg amputation, reconstruction with osteomyocutaneous turn-up plasty as described by Sauerbruch | Femur-removal, lower leg amputation, reconstruction with osteomyocutaneous turn-up plasty as described by Sauerbruch, pedicled flap reconstruction |
Comorbidity (severe PVD) | Vascular imaging, Free flap reconstruction, lower limb amputation | Transfemoral amputation |
New clinical information (soft tissue of forefoot viable) | Forefoot amputation, chimeric free flap reconstruction of foot | Osteosynthesis, free flap reconstruction of the feet, skin grafting |