Article

Noninvasive arterial studies have been used to determine level of
amputation. The objective of this study was to examine each component of the
noninvasive arterial studies to determine optimal cut points to predict healing
and to evaluate whether physiologic maneuvers could improve the utility of
transcutaneous oxygen pressure (TcPO2) values to predict healing of partial foot
amputation. DESIGN: The authors conducted a retrospective, observational study of
307 patients who underwent partial foot amputation and had noninvasive arterial
studies in the perioperative period. RESULTS: The TcPO2 values were significantly
predictive of healing. Specifically, a cut point TcPO2 value of 38 mm Hg had a
sensitivity and a specificity of 71% for predicting healing or failure. The
optimal cut point was mostly unaffected by patient characteristics. The addition
of noninvasive arterial studies recorded in a position with the limb elevated
improved prediction in the subgroup with supine TcPO2 values of 38 mm Hg or
lower. CONCLUSIONS: The findings of this study validate previous reports and
confirm that TcPO2 measurements are valuable to more accurately determine the
correct amputation level and, in turn, obtain better outcomes. TcPO2 measurements
may provide better prognostic value than do ankle-brachial indices for healing
after partial foot amputation. TcPO2 measurements are useful but should not be
used in isolation to make treatment decisions regarding amputation level.

Langue : ANGLAIS