Zivot Limb Preservation Centre – North works to save limbs
More than a decade after surgeons first pushed for it, the Zivot Limb Preservation Centre – North has opened at the Stelmach Community Health Centre, bringing podiatric and vascular surgeons together to save limbs that might otherwise be lost. In less than a year, the clinic has grown from a handful of patients a day to nearly 200 a month.
A clinic to close gaps
A small blister. A patch of red skin on the bottom of a foot. For someone with diabetes or poor circulation, this can be the first step toward losing a limb, and the patient may not even feel it happen.
"You might have some rubbing or irritation to an area of the foot that your eye might catch, but they won't until they take their shoe off," says Dr. Kevin Perry, a podiatric surgeon with the clinic. "And I can see there's a big wound underneath there."
That is the gap the Zivot Limb Preservation Centre – North was built to close. Located at the Stelmach Community Health Centre in southeast Edmonton, it's the northern counterpart to the original Zivot Limb Preservation Centre in Calgary, where Perry trained before helping bring the model to Edmonton. In less than a year, Perry says the clinic is already seeing strong demand.
A decade in the making
Dr. Winkelaar, the former head of vascular surgery in the Edmonton zone, was the driving force behind bringing a similar clinic here, working toward it for more than 10 years. Perry also credits donations from the Zivot Foundation, run by Dr. Mark Zivot, the Calgary podiatric surgeon who helped start the province's original clinic, along with years of advocacy from Dr. Cliff Sample, now Covenant Health's chief medical officer.
"I think a lot of it comes down to resources and space available," Perry says. "Having the space become available is what sort of brought the clinic together."
The timing lined up for Perry personally, too. Originally from Edmonton, he studied podiatric medicine in Philadelphia before completing a three-year surgical residency in Kentucky, focused on reconstructive rear foot and ankle surgery. He then moved back to Alberta and spent a few years in private practice in Calgary, followed by a year-long fellowship at the original Zivot Limb Preservation Centre, known as the Rose Zivot fellowship in honour of Dr. Zivot's late mother. He moved back to Edmonton just as the Stelmach Community Health Centre was opening.
The "toe and flow" model
The clinic runs on what's known as the toe and flow model, an approach Perry says was first described in a 2010 study in the Journal of Vascular Surgery.
"The toe portion is the podiatric surgery portion, and the vascular portion is the flow portion," Perry says. "They've sort of formed the backbone of this interdisciplinary clinic." Other specialists, including infectious disease, internal medicine and plastic surgery, join as needed.
Dr. Kevin Perry consults with a patient at the Zivot Limb Preservation Centre – North.
Diabetes at the centre of care
Most patients who end up at the clinic live with diabetes, peripheral arterial disease or peripheral neuropathy, often some combination of the three, Perry says. Diabetes slows healing, neuropathy can mask a wound forming, and poor circulation makes it harder for the body to repair itself.
Because diabetes plays such a large role, the clinic works closely with the diabetes clinic on the Stelmach Centre's third floor, referring patients back and forth as needed. Staff there send down anyone with a foot wound spotted during a checkup, and Perry's team sends patients upstairs when their blood sugar isn't well managed.
"That does play a big role in healing, for sure," Perry says.
Working together under one roof
Sharing a building with other services means patients aren't running across the city between appointments, Perry says. MIC Medical Imaging is on the same floor for X-rays, and plastic surgery runs the same day, so specialists can consult in person.
"It just alleviates, I think, the patient's anxiety of having to go around the city to multiple different locations to be treated for the same thing," Perry says. He hopes that as the clinic grows, it can also ease pressure on the emergency department by seeing more patients within a day or two.
Why catching problems early matters
Perry points to studies showing a five-year mortality rate of between 40 and 80 per cent for patients who undergo a major amputation.
"When you save someone's limb, you can maintain their independence and their ability to function on a higher level," Perry says.
He also points to Calgary, where he says studies found Edmonton had more than double the number of major amputations compared to Calgary since that clinic opened. He expects a similar shift here as the Edmonton clinic grows.
A clinic that's already growing fast
The clinic saw its first patient in November, Perry says. Daily patient volumes have grown from six or seven to close to 30, and the clinic saw almost 200 patients in June alone. It currently runs two to two and a half days a week, with a goal of eventually running five, matching Calgary. Perry is the only podiatric surgeon on the team for now, but he expects that to change as demand grows.
"The sooner you can get treatment started, the less chance of a severe infection developing," Perry says. "If you're able to get things done earlier, then you can hopefully prevent the need for those major amputations."
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