A multivariate analysis of determinants of wound healing in patients after amputation for peripheral vascular disease.
In a prospective study 53 patients undergoing amputations of the lower limb were evaluated for clinical criteria, laboratory results, pulse volume recordings, Doppler pressures, Photoplethysmographic Skin Perfusion Pressures (PPG/SPP) and angiography. The purpose of the study was to analyse which of these techniques predicts wound healing adequately after amputation. Forty-five patients eventually completed all tests. With the exception of PPG/SPP none of these tests were able to predict skin healing. The technique of PPG/SPP proved very reliable in helping to select the level of amputation, if measured anteriorly (P = 0.0001, r = 0.83). Angiographic scoring also correlated significantly (P = 0.0016) with a successful result. This study suggests that surgeons should not rely on their clinical acumen for the selection of the amputation level. In the absence of a reliable non-invasive test, angiography may well be useful but PPG/SPP will enable the surgeon to amputate on an optimal level and thus reduce complications and improve rehabilitation.
van den Broek
T A
TA
Department of Vascular Surgery, Free University Hospital, Amsterdam, The Netherlands.
Dwars
B J
BJ
Rauwerda
J A
JA
Bakker
F C
FC
D000368:Aged; D000671:Amputation, Surgical; D000672:Amputation Stumps / Q000503:physiopathology*; D000792:Angiography; D003925:Diabetic Angiopathies / Q000601:surgery*; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D015999:Multivariate Analysis; D010991:Plethysmography; D011446:Prospective Studies; D012879:Skin Physiological Phenomena; D014652:Vascular Diseases / Q000601:surgery*; D014945:Wound Healing