Limb-Saving Toe and Flow Model | Dr. Alex Reyzelman

Limb-Saving Toe and Flow Model | Dr. Alex Reyzelman
Diabetic Foot Ulcers that don’t heal are the leading cause of amputation. To heal these ulcers effectively requires a multidisciplinary approach. That approach includes a highly trained vascular specialist to restore flow to the small vessels below-the-ankle and a podiatric specialist highly trained in wound care with experience working with a vascular specialist to ensure more perfusion in the tissue surrounding the wound. Dr. Alex Reyzelman briefly describes the importance of the Toe & Flow Model to UCSF’s Center for Limb Preservation and the patients it serves.

Before adopting a Toe and Flow model, what gaps did you face in the care of patients with Peripheral Artery Disease and Diabetic Ulcers at UCSF?

We found that vascular surgeons and podiatrist tend to work in their own silos and there’s valuable time that is lost when trying to get a patient from a vascular surgeon to a podiatrist and vice versa.

Describe how the “Toe and Flow” structure for treating patients with Peripheral Artery Disease and Diabetic Foot Ulcers has filled the gaps in patient care and additions you have made that are unique to UCSF.

Having a team approach and a one-stop-shop in evaluating a patient makes all the difference in the world. The patient gets a comprehensive evaluation of their circulation and their foot wound at the same time. Decision is made via a team approach without wasting valuable time.

How does the Toe and Flow structure impact patient compliance with critical lifestyle changes such as diet, exercise, and smoking cessation which has a low overall rate with Peripheral Artery Disease patients globally?

The toe and flow team pays close attention to follow-up and surveillance. Once the foot is saved, it’s important to follow the patient to make sure that we minimize the recurrence of foot injuries. This close surveillance allows the team to continue educating the patient regarding the lifestyle modifications and lowering their risk factors.

How do you see this model scaling to include implementation in the growing number of Office-Based Labs and Ambulatory Surgical Centers?

The key to saving limbs is a “Team Approach”. The team of dedicated vascular and podiatric surgeons who specialize in limb salvage is what’s needed in order to scale and implement limb salvage centers throughout the United States and the world.

What data do you have that show the successful implementation of a Toe and Flow structure that would inspire other facilities to follow suit?

We have our own 10 years of experience at UCSF. Our outcomes have been published in peer reviewed journals.