More Than Just a Limb: Challenging Functional Assumptions in the Management of CLTI in a Paraplegic Patient

Chronic limb-threatening ischaemia (CLTI) usually prompts urgent revascularisation to prevent amputation and preserve mobility. In patients with longstanding paraplegia, however, the perceived functional value of the limb may be underestimated, influencing clinical decision making. This case highlights how patient-centred assessment can challenge assumptions about disability and guide ethical management. A 77-year-old man with T8 paraplegia presented with progressive toe necrosis and severe iliac and femoral arterial disease. Although initially reluctant to undergo surgery, progression of tissue loss led him to reconsider. Within the multidisciplinary team (MDT), some members, who had not assessed the patient directly, questioned the benefit of revascularisation in a non-ambulatory individual. Clinicians who had examined him emphasised that he used his legs for transfers, postural stability, and cardiovascular exercise, and that the limb held significant psychological value. Following patient-centred discussion, the MDT agreed that intervention aligned with his goals. He underwent successful open revascularisation. Postoperative recovery was uncomplicated, and the patient was discharged home one week later with preserved limb perfusion and a clear plan for wound care and rehabilitation. This case challenges the assumption that paraplegic patients derive limited benefit from limb salvage. Functional contribution extends beyond walking, and mobility status alone should not determine treatment suitability. Direct clinical engagement is crucial to understand how a limb supports independence and identity. Recognising and addressing ableist biases within MDT decision making ensures ethical, personalised management of CLTI in patients with disability.