Limb Preservation

The Washington University limb preservation team helps patients with traumatic injury or complications from disease avoid amputation with our advanced and specialized limb preservation service.

We treat patients at risk for losing part of an arm or a leg, or patients who already suffered limb amputation but need additional care to treat lingering pain or limb deformity.

Working closely with interventional radiologists, our board-certified and fellowship-trained orthopedic surgeons use advanced techniques to save limbs, preserve function of the arm or leg and help complex wounds safely heal. Our limb preservation team helps with the treatment of malunion and nonunion, infection and osteomyelitis, as well as skeletal and soft-tissue defects using osteotomy, bone grafting, debridement, bone transport, and rotational and free-tissue transfer techniques. 

Why Choose Washington University Orthopedics for Limb Preservation

Our limb-preservation specialists are national leaders in their fields, setting the standard for care across the country. Office visits are available across eight St. Louis-area locations, including the Washington University Medical Center — home to Barnes-Jewish Hospital, a Level-1 trauma center.  Patients receive care from skilled and trusted specialists with state-of-the-art technology.

With extensive experience in soft tissue and skeletal reconstruction and nerve injury repair, we use a  thorough approach to treat these complex injuries and wounds.

Whether you see our limb preservation team immediately after an injury (usually through the emergency room), are transferred from another hospital, or request an appointment in our dedicated Limb Preservation Clinic, you can trust you will receive skilled and compassionate care.

Common Conditions/Indications for Referral

• Patients with immediate traumatic injuries to limbs

• Workers compensation patients

• Patients with stabilized injuries requiring specialized intervention to preserve function and avoid deformity

• Patients with an arm or leg amputation who need additional care to eliminate pain, numbness or other symptoms

• Patients with an arm or leg amputation who’d like access to advanced prosthetics

Treatment Approach

We help patients at every stage of a traumatic injury or wound complication. There are three main points of entry to the Washington University Limb Preservation Service:

• A patient experiences a traumatic injury to an arm or leg, such as a car or work accident, and comes to the Barnes-Jewish Hospital emergency room. Our specialized team is called to help patients with at-risk limbs avoid amputation.

• A patient experiences a traumatic injury and is taken to their local community hospital. The patient’s condition and injury are stabilized, and the patient is then transferred to the Washington University limb preservation team for specialized care to prevent amputation.

• Some time has passed since a patient’s injury or amputation, and he or she is experiencing pain, numbness or loss of function. We see the patient in an outpatient office visit, perform a comprehensive review of his or her condition, and develop a treatment plan to restore the patient’s quality of life.  

What to Expect at Your First Appointment

At your first appointment, please bring with you all imaging/radiology studies and operative notes from previous providers, as well as any photos taken at the time of injury or throughout the recovery process.

You will meet with one of our orthopedic doctors for evaluation, beginning with a thorough history, physical exam of the affected limb and review of all imaging. Depending on your condition, you may be scheduled for additional tests, including X-rays, CT scan, MRIs, vascular evaluation and/or electrophysiologic testing.

Our orthopedic surgeons then meet as a team to discuss to limb salvage for each unique patient. Fractures, bone defects, soft tissue concerns, poor blood supply and nerve pain are all addressed as they relate to your injury. A care plan is then created and discussed with you to help your healing and recovery.

You will be cared for by this same team for your entire journey — from pre-operative office visits to hospitalization and recovery — until function has been restored and your wound or injury is healed.

Patients with Existing Amputations

For patients who have already undergone amputation, or for those where limb salvage is not possible, our team offers the latest advances in surgical techniques to minimize phantom and neuroma pain at the site of the amputation. This is done through targeted muscle reinnervation (TMR), where the nerve ends at the amputation site are “rewired” to other muscles in a process that has been proven to decrease pain long-term. This also helps fitting and patient control of advanced prosthetics that can dramatically improve limb function.

Goal of Treatment 

Our goal is to help patients:

• Avoid limb loss after mangling injuries or injuries complicated by infection.
• Treat the patient’s entire injury, including an underlying fracture or disease state or infection, and heal injuries with a goal of maximizing function.
• Preserve function and feeling in arms or legs.
• Eliminate phantom limb pain with targeted muscle reinnervation techniques.
• Help patients with arm or leg amputations regain function with advanced myoelectric prosthetics and cutting-edge surgical techniques, making control of robotic prosthetics intuitive and seamless.  

Benefits of Treatment

Modern surgical techniques in the hands of skilled and experienced specialists have pushed the boundaries of how we can help patients with complex limb injuries. By combining specialists with expertise in a variety of areas, we help patients restore function to their injured arm or leg as quickly as possible. Patients with severe soft tissue and bone injuries may take longer to recover given the complex nature of their problem. We address all aspects of the patient’s condition to minimize the risk of additional illness or injury, and to speed up the recovery process.