title: Clinical reliability and utility of skin perfusion pressure measurement in ischemic limbs--comparison with other noninvasive diagnostic methods.
abstract: OBJECTIVE
  We studied whether the measurement of skin perfusion pressure (SPP) is useful for evaluating ischemic limbs and predicting wound healing.
  
  
  METHODS
  Two hundred eleven patients (age range, 45 to 90 years; mean age, 69.6 +/- 9.2 years; 170 men and 41 women), 403 limbs with arteriosclerosis obliterans, were included in this study. Half of the patients had diabetes or were receiving dialysis or both.
  
  
  RESULTS
  Significant correlations were found between SPP and ankle blood pressure (ABP), SPP and toe blood pressure (TBP), and SPP and the transcutaneous oxygen pressure (tcPO2) (P < .0001, r = 0.75; P < .0001, r = 0.85; P < .0001, r = 0.62; respectively). In 94 limbs with ulcer or gangrene, wound healing was predicted by the SPP. The mean SPP (mean +/- SD) in the healed-wound group (25 limbs, 48 +/- 20 mm Hg) was greater than that in the unhealed-wound group (69 limbs, 23 +/- 11 mm Hg) (P <.001). According to the receiver operating characteristic (ROC) curve, the cut-off value of SPP was 40 mm Hg (sensitivity, 72%; specificity, 88%). Furthermore, we studied whether the combination of SPP and another measurement could predict wound healing more accurately than could any single variable. There was a strong correlation between SPP, TBP, and the healing rate (P < .001, r = 0.69) and healing could be accurately predicted if the SPP was greater than 40 mm Hg and if the TBP was greater than 30 mm Hg.
  
  
  CONCLUSIONS
  Our results suggest that measurement of SPP is an objective method for assessing the severity of peripheral arterial disease or for predicting wound healing.
authors.affiliation: Department of Vascular Surgery, Aichi Medical University, Aichi-gun, Aichi, Japan. ohta1221@aichi-med-u.ac.jp <ohta1221@aichi-med-u.ac.jp>
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Yamada
authors.forename: Takashi
authors.initials: T
authors.lastname: Ohta
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ishibashi
authors.forename: Ikuo
authors.initials: I
authors.lastname: Sugimoto
authors.forename: Hirohide
authors.initials: H
authors.lastname: Iwata
authors.forename: Masayuki
authors.initials: M
authors.lastname: Takahashi
authors.forename: Jun
authors.initials: J
authors.lastname: Kawanishi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000842:Ankle / Q000098:blood supply; D001162:Arteriosclerosis Obliterans / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D001785:Blood Gas Monitoring, Transcutaneous; D001794:Blood Pressure; D005121:Extremities / Q000098:blood supply*; D005260:Female; D005734:Gangrene; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D017078:Laser-Doppler Flowmetry; D007871:Leg Ulcer / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017156:Photoplethysmography; D011237:Predictive Value of Tests; D012372:ROC Curve; D012039:Regional Blood Flow; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012867:Skin / Q000098:blood supply*; D014034:Toes / Q000098:blood supply; D014463:Ultrasonography; D014945:Wound Healing