TcPO2 as an accurate predictor of therapy in limb salvage.
One hundred forty-seven consecutive patients with limb-threatening acute diabetic pedal sepsis and/or chronic ischemia (Fontaine III/IV) were prospectively studied. Forty-four with palpable pulses underwent successful surgery (major or minor amputation, incision, and drainage) without further evaluation; 103 with decreased or absent pulses had baseline TcPO2 measurements. Fourteen patients with values > or = 30 mm Hg underwent major or minor amputation with 91% (13 of 14) healing success. Ninety patients with values < 30 mm Hg underwent arteriography with 98% (87 of 89) showing significant disease. Of these, 22 did not undergo revascularization and only 50% (11 of 22) showed primary healing following minor amputation or debridement. Sixty-seven patients underwent 74 revascularization procedures; 95% (64 of 67) showed improvement of TcPO2 > 30 mm Hg and of these, 91% (58 of 64) had healing of minor amputation or debridement sites (p < 0.05). TcPO2 measurements may be used to direct therapy because they have been shown to accurately predict the presence of significant vascular disease, its appropriate correction by means of revascularization, and the success of major or minor amputations with or without revascularization.
Bunt
T J
TJ
Maricopa Medical Center, Phoenix, Ariz, USA.
Holloway
G A
GA
D000465:Algorithms; D000671:Amputation, Surgical; D001166:Arteriovenous Shunt, Surgical; D001785:Blood Gas Monitoring, Transcutaneous; D017719:Diabetic Foot / Q000097:blood* / Q000601:surgery; D006801:Humans; D016491:Peripheral Vascular Diseases / Q000097:blood* / Q000601:surgery; D011446:Prospective Studies; D014945:Wound Healing