The Manchester Amputation Reduction Strategy (MARS) aims to save limbs and lives.  Whilst the title suggests the focus is saving limbs, it is, in reality, a comprehensive strategy to heal foot and leg ulcers faster.  The aim is to harmonise services and protocols across Greater Manchester, and, together with a new IT system, bring together Public Health as well as Health and Social Care Services across both community and secondary care.  

Why did I set up MARS?

MARS brings together my research and clinical interests and is the culmination of a passion to reduce unfairness within the health system.  I wish to reduce the health inequalities surrounding lower limb amputations.  Currently, there are more amputations in the North of England compared with the South, more in men than women and more in Black than White populations.  As a surgeon, once people get to me, there is all too often, too little I can actually do.  The best thing to do is to stop people needing to see me in the first place.  

What are the causes of an amputation?

There are four main causes of an amputation; these are peripheral arterial disease, diabetes, venous disease and lymphoedema.  They all lead to an amputation by causing foot and leg ulcers.  It should be remembered that whilst most amputations are the result of diabetes and peripheral arterial disease (they cause foot ulcers), most leg ulcers are the result of venous disease and lymphoedema.  Whilst leg ulcers rarely lead to an amputation, they are far more common than foot ulcers and therefore a far greater burden on the health service.  

Another major cause of differences in outcome is the way ulcers are treated in both the community and hospital.  If we can collect examples of excellence in practice and share them i.e. re-design services putting the patient first we will go a long way to removing inequalities.  

Why link foot and leg ulcers?

Both foot and leg ulcers are treated in the community by the same people i.e. i.e. district nurses, podiatrist and tissue viability nurses with the principles and practice of treating them being the same.  However, they are often thought of as separate entities and good practice is therefore rarely shared.  One way of sharing learning is to develop wound care teams.  MARS wishes to gather examples of excellence in practice, and, with the help of people on the ground, put it all together.  By getting all ulcers healed faster – and then staying healed, we can make a real difference.  


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