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Michael E. DeBakey VA Medical Center - Houston, Texas

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Docs Battle for Medal of Honor Recipient to Keep His Leg

June 3, 2010

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Medal of Honor Recipient David McNerney exercises his legs with his DeBakey VA surgeons, Panagiotis Kougias, M.D., chief of the Vascular Surgery Section (left), and Carlos Bechara, M.D., staff vascular surgeon. PHOTO: Bobbi Gruner

HOUSTON - Army Veteran David McNerney knows about fighting. He was awarded the Medal of Honor for his bravery and courage when his unit was attacked by a North Vietnamese battalion near Polei Doc. His story and that of his unit is told in the recently produced documentary, “Honor in the Valley of Tears.” However, in the last few weeks, McNerney has been fighting a different kind of battle; a struggle to keep his leg.

“The Michael E. DeBakey VA Medical Center recently established a limb salvage program to help prevent amputations and improve the quality of life of our Veterans,” said Panagiotis Kougias, M.D., chief of the Vascular Surgery Section and also an assistant professor of Vascular Surgery at Baylor College of Medicine. “Mr. McNerney’s medical case represents the typical patient who can benefit from such a program.”

The reality of leg amputation, whether partial or full, is one faced by more than 200,000 people every year. There are an estimated 1.7 million people living with limb loss in the United States alone. Reasons for limb loss range from trauma to infection, diabetes to cancer, and vascular disease to other various diseases.

At the Michael E. DeBakey VA Medical Center (MEDVAMC), Kougias is leading a multidisciplinary, collaborative effort involving vascular surgery, plastics, orthopedics, interventional radiology, internal medicine, cardiology, infectious disease, podiatry, and patient education to prevent amputations. The program focuses on patients who suffer from critical limb ischemia (CLI), a severe obstruction to the arteries that decreases blood supply to the extremities. CLI is a symptom of peripheral arterial disease.

The only solution for limb salvage in patients with CLI is revascularization. This can be achieved with either open surgical bypass procedures, or endovascular interventions such as balloon angioplasty and stenting. More complex forms of arterial obstruction require “hybrid” operations. These combine the open and endovascular approaches, and are performed by surgeons highly skilled in both. Appropriate facility infrastructure with technically advanced imaging equipment and a broad range of endovascular surgical supplies is essential. Hybrid operations are routinely performed at the MEDVAMC as part of limb salvage procedures.

“I really wanted this procedure and have the greatest confidence in the doctors and nurses at the DeBakey VA,” said McNerney the day after his surgery. “Already, I can feel such an improvement in my leg, foot, and toes. I can’t wait to get up and walk without numbness and pain I felt before.”

“All too often, the first steps to an amputation occur with a small wound that doesn’t heal. Then the sequence is gangrene, loss of a digit, and then loss of a limb. When someone loses a limb, they often times end up losing their life,” said Carlos Bechara, M.D., staff vascular surgeon and also an assistant professor of Vascular Surgery at Baylor College of Medicine.

Veterans exhibiting leg pain or symptoms not easily explained by arthritis are urged to see their doctor. Diabetics should see their health care provider regularly to prevent circulation problems before they start.

“We want to give Veterans every chance to keep their limbs and live a full life,” said David H. Berger, M.D., M.H.C.M., Operative Care Line executive and professor of Surgery at Baylor College of Medicine. “The Michael E. DeBakey VA Medical Center constantly strives to open new doors and make new medical alternatives available for our Veterans.”

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