Southern Arizona Limb Salvage Alliance (SALSA) - Department of ...

Saving Limbs & LivesSome 86,000 Americans undergodiabetes-related lower-leg amputationseach year. Amazingly, 90 percent of theseamputations are completely preventableaccording to David G. Armstrong, DPM,MD, PhD, and Joseph L. Mills, MD,co-directors of the Southern ArizonaLimb Salvage Alliance (SALSA) at theUniversity of Arizona Department ofSurgery and University Medical Center.Joseph L. Mills, MD and David G. Armstrong, DPM, MD, PhDSALSA ClinicUniversity Medical Center1501 N. Campbell AvenueTucson, Arizona 85724(520) 694-6690Outside Tucson: (800) 524-5928Poorly controlled diabetes frequentlyresults in nerve damage and poorcirculation to the legs and feet. Patientsgradually lose their ability to sensefoot pain or symptoms of injury. Thisloss of protective sensation (LOPS, thebody’s warning system) makes it easyfor blisters, cuts, and sores to gounnoticed, leading to infection, footulcers, reduced mobility, and, all toooften, major amputation.http://diabeticfootonline.comhttp://ToeandFlow.com/ (blog)www.umcarizona.orgwww.surgery.arizona.eduThe Southern Arizona Limb Salvage Alliance (SALSA)is a part of University Medical Center (UMC) inTucson, Arizona, a not-for-profit hospital affiliatedwith the University of Arizona College of Medicine.Southern Arizona LimbSalvage Alliance (SALSA)The University of Arizona Department of Surgery

Southern Arizona LimbSalvage Alliance (SALSA)A Team ApproachThe Southern Arizona Limb Salvage Allianceuses a multidisciplinary team approachto wound healing and prevention ofamputations in people with diabetes.The SALSA program has two integralcomponents: Podiatry (toe) and VascularSurgery (flow). The program also combinesthe expertise of researchers and specialists inareas such as orthopedics, infectious disease,plastic surgery, physical therapy, stem celltherapy, wound treatment, psychology, andpsychiatry. Ultimately, our goal is preventionof the foot problems that can lead toamputation.Patients who arrive with foot ulcers andinfections are thoroughly assessed by teammembers to determine the extent of theinfection and the most appropriate treatment.We evaluate the blood flow, the underlyingarchitecture of the foot, and the type andextent of the infection.Thanks to the expertise of our team andstate-of-the-art technology, our patients canbegin receiving treatment within a matterof minutes of arrival at University MedicalCenter. Evaluation and treatment are rapidand integrated.Toe and FlowThe SALSA program has spearheaded the“toe and flow” concept and is recognizedinternationally for this innovative treatmentapproach. SALSA vascular surgeons andtechnologists assess blood flow noninvasivelyon each patient and correct major flowproblems with endovascular and opensurgery when needed. Podiatry, the toecomponent, manages the offloading andmechanical foot problems to ensure healingand prevent ulcer recurrence.Diabetic foot wounds tend to “heat up”before the skin “breaks down.” Amongthe tools the SALSA team uses is thermalimaging, which detects this heat.Once the affected area is identified, itis targeted for intervention, if required,to improve blood flow. With blood flowrestored, our patients’ ability to heal isenhanced. Our team will then remove thedead or infected tissue from the wound andperform needed reconstructive surgery.The SALSA program is one of the few inthe world that can handle such complexprocedures.Education and PreventionBecause the best surgeryis the one that never hasto be done in the firstplace, patient educationrepresents a strongcomponent of theSALSA program. Some15 percent of diabeticsdevelop a foot ulcerduring their lifetime.Patients need to be awareof the need to keep theirfeet clean and healthy andto be ever vigilant withany type of injury. Once infection sets in,patients are in serious danger of amputation.Clinical TeamDavid G. Armstrong, DPM, MD, PhDProfessor of SurgeryDirector, SALSAJoseph L. Mills, MDProfessor of SurgeryChief, Vascular and Endovascular SurgeryCo-director, SALSAJohn D. Hughes, MDAssociate Professor of SurgeryDaniel M. Ihnat, MDAssistant Professor of SurgeryKaoru R. Goshima, MDAssistant Professor of SurgeryTimothy K. Fisher, DPMInstructor in SurgerySALSA Diabetic Foot Fellow