Sample Solution

ith exposed bone, joint, or tendon, or shallow heel ulcer without involvement of the calcaneus( ie. Major tissue loss: salvageable with >3 digital amputations or standard transmetatarsal amputation plus skin coverage). Grade 3 is an extensive deep ulcer of the forefoot and/or midfoot, or full thickness heel ulcer with or without involvement of the calcaneus(ie. Extensive tissue loss: salvageable only with complex foot reconstruction or nontraditional TMA). Patient is a grade 2 for wound because he had a deep ulcer.
Ischemia also has grades 0-3. Grade 0 is ABI (ankle-brachial index) > 0.8, with ankle systolic pressure >100mmHg, toe pressure(TP) >60. Grade 1 is ABI 0.6-0.79, ankle systolic pressure 70-100mmHg, TP 40-59. Grade 2 is ABI 0.4-0.59, ankle systolic pressure 50-70mmHg, TP 30-39. Grade 3 is ABI <0.39, ankle systolic pressure <50mmHg, TP <30.
The third category is foot infection. Grade 0 is no symptoms or signs of infection. Grade 1- infection is present and at least 2 of the following are present: local swelling, erythema >0.5 to <cm around ulcer, local tenderness or pain, local warmth, or purulent discharge. Other causes of an inflammatory response of the skin have been excluded(gout/fracture). Grade 2 is a local infection is present as defined for Grade 1, but extends > 2cm around ulcer, or involves structure deeper than the skin and subcutaneous tissues(eg. Abscess, osteomyelitis, septic arthritis, fasciitis). No clinical signs of systemic inflammatory response. Grade 3 is a local infection that is present as defined for Grade 2, but clinical signs of systemic inflammatory response are present as manifested by 2 or more of the following: temperature >38°C or <36°C; heart rate >90 beats per minute, respiratory rate >20 breaths per minute or PaCO2 <32 mmHg; white blood cell count >12,000 or <4000 (cu/mm) or >10 percent immature band forms present. Patient is grade 2 for foot infection, in which he had a local infection on his foot that was 2cm by 2cm, and involves structure deeper than the skin and subcutaneous tissues.
Based on these considerations, the patient with PAD can be placed into one of four amputation risk categories (very low, low, moderate, high). Patient had to amputate his 2nd and 3rd L toes.