August 9, 2024

On Friday, August 9, attendees at The National will take a deep dive into surgical offloading for limb preservation in high-risk patients with diabetes with Colin Mizuo, DPM, and Jacob Wynes, DPM, MS. In this incisive presentation, which will include case discussion, Drs. Mizuo and Wynes, along with moderator John Steinberg, DPM, will examine some underutilized approaches, as well as how to balance your surgical plan with an individual patient’s needs and expectations.

Dr. Wynes will cover perils, pitfalls, and pearls for success in Charcot deformity reconstruction, focusing on patients who have open wounds. Dr. Mizuo will discuss tendon balancing to offload wounds, a procedure he says is “not for everybody.” Both surgeons emphasize the importance of a thorough work-up of the patient to understand why a wound is there in the first place (is it being caused by instability? a misshapen foot?) before determining the appropriate surgical approach.

“Some patients may want to go through the gauntlet to do everything they can to save their leg and not have a below-knee amputation. We owe it to those patients to offer the range of what we can do,” Dr. Mizuo said. “With some patients, we may be battling socioeconomic factors or lack of family support. Your decision-making is not just procedure choice. It’s the things you don’t learn as a student or resident.”

Dr. Wynes agreed that understanding patient expectations is paramount. “Your proposed intervention has to be book-savvy but also patient-modified,” he said.  

The case presentation built into this session will lend an element of fun but is also designed to help the audience learn from the presenters’ experience. “I’m at that point now where I’m happy to share some of my missteps,” Dr. Wynes said. “Probably the best question I ever got from an audience was, ‘What’s the dumbest thing you ever did?’ That’s a tough one to answer publicly, but there’s value in that.”

The debate also will demonstrate that there’s more than one right approach. “There’s not always one way to attack something,” Dr. Mizuo said. “You realize it’s the grey areas that can make decision-making difficult.” He said Dr. Steinberg, his former residency director, shines as a moderator by highlighting some of those grey areas. “He will throw a wrench into the discussion that will change your perspective.”

The presenters believe the session will offer a little something for everyone and should provide attendees with pearls to take into their practices on Monday. “Diabetic limb salvage is where there is the greatest need for us; it is our staple,” Dr. Mizuo said.

“This is a very generalizable session,” Dr. Wynes said. “Hopefully there will be lessons in it for everyone.”