Losing one leg is frightening enough for most people. Even more frightening is having already lost one leg and then facing the possibility of losing the other.

An elderly woman in her seventies had lived with diabetes for many years. More than ten years earlier, a wound on her right leg had been managed poorly, leading to infection and progressive tissue death. To prevent further deterioration and a life-threatening situation, she ultimately had to undergo an amputation below the knee.

Despite losing one leg, she remained very positive, learned to use a prosthesis, and was still able to move around and care for herself. A few months ago, however, one toe on her left foot developed a wound and gradually turned black. An orthopaedic assessment suggested that the toe had already become gangrenous and needed to be removed.

After surgery, the wound on the toe was cleaned for several months but still would not heal. She was warned that because circulation in the leg was poor, the tissue death might spread further upward, with a real risk of amputation.

Hearing the word “amputation” left her terrified. She lived in constant fear and even told her family that she would rather live or die with her remaining left leg.

She was later referred to vascular surgery, where assessment showed severe narrowing and blockage in the arteries of the left leg, explaining the toe gangrene and confirming that the risk of amputation was indeed real. She underwent minimally invasive endovascular angioplasty. Through a small puncture in the artery at the groin, fine instruments were passed into the blocked vessels to reopen and widen them, and a stent was inserted. After the procedure, the pulse in her foot returned. The chronic toe wound, which had persisted for a long time, gradually healed over the following weeks, and most importantly, the immediate risk of amputation was avoided.

Author: Honorary Clinical Associate Professor, Department of Surgery, The University of Hong Kong; President, Vascular Health Foundation