Amputation limits a person’s independence and affects their quality of life. Doctors and healthcare providers often examine the lower extremities, such as the legs and feet, of patients with diabetes because these individuals are at a higher risk for amputation. Dr. Charles de Mestral, a vascular surgeon and scientist at St. Michael’s Hospital, has firsthand experience treating these patients and conducts research to not only better understand their conditions, but also work towards preventing limb loss in individuals living with diabetes.

Dr. de Mestral attended McGill University for medical training and conducted his doctoral research at the University of Toronto. Afterwards, Dr. de Mestral completed a residency in General Surgery and Vascular Surgery at the University of Toronto. Currently, Dr. de Mestral is an Assistant Professor in the Department of Surgery at the University of Toronto and an Adjunct Scientist at the Institute for Clinical Evaluative Sciences (ICES). His research focuses on the effectiveness of care and amputation prevention for patients with diabetes and peripheral arterial disease in Canada.

Leg and foot amputations are a severe complication often associated with diabetes and peripheral artery disease, which lead to narrow blood vessels. The narrowing of the blood vessels reduces blood flow, depriving neurons of oxygen and nutrients, and causing loss of sensation. Dead tissue begins to accumulate in the toes and then spreads, becoming chronic wounds when left untreated. In severe cases, some patients can even step on a nail and feel no pain because of the extent of tissue damage. In these instances, amputation of the damaged limbs can contain the tissue damage before it spreads to other areas of the body.

The goal of Dr. de Mestral’s research is to improve clinical effectiveness, including increasing the quality of surgical procedures for patients and reducing medical costs for the government. His research has highlighted that diabetes-related amputations are a real public health concern with the rising rates of diabetes in Canada and the United States. His research pursuits will identify preventive measures that can directly decrease limb loss in patients with diabetes while helping clinicians to further understand the impact of amputations on a patient’s life.

A 2020 study by Dr. de Mestral’s team found that diabetes-related amputations greatly varied depending on geographic location and socio-economic status in Ontario. There was a higher amputation rate among patients living in rural and northern areas, possibly due to a lack of health service-related resources. Dr. de Mestral hopes that his research will provide valuable insights on regional disparities and social contexts to consider when developing regional amputation preventive programs for patients.

In addition to his clinical and research work, Dr. deMestral is the Vice Chair of the Ontario Health Technology Advisory Committee, which aims to provide evidence-based recommendations about healthcare services to the Minister of Health and Long-Term Care. In 2019, Dr. de Mestral was awarded an Ontario Early Career Researcher Award from Diabetes Action Canada for foot care and amputation prevention research. His continuous research efforts in diabetes-related amputation will provide insight into regional differences across Canada and encourage multidisciplinary care to improve lower limb screening for patients.

— Written by Rebecca Dang