Predictive value of routine transcutaneous tissue oxygen tension (tcpO2) measurement for the risk of non-healing and amputation in diabetic foot ulcer patients with non-palpable pedal pulses.
BACKGROUND
It was evaluated whether transcutaneous tissue oxygen tension (tcpO2) measurement, when assessed in daily routine, can be used to predict the risk of non-healing and amputation in diabetic foot ulcer patients with non-palpable pedal pulses.


METHODS
Patients were followed up in an outpatient setting according to a comprehensive wound-care protocol. tcpO2 measurements were performed at the dorsum of the forefoot in a standardized setting. Patients were divided into three subgroups according to their initial tcpO2-readings (tcpO2 <20 mmHg, tcpO2 20-40 mmHg, tcpO2 >40 mmHg). Patients with clinical signs of soft tissue infection at the initial presentation were excluded.


RESULTS
One hundred forty-one patients were enrolled. Wounds associated with a tcpO2 reading <20 mmHg demonstrated a significantly decreased probability of healing compared with those associated with a tcpO2 >40 mmHg (p=0.008). In addition, the risks of soft tissue infection (p=0.057) and hospitalization during follow-up (p=0.019) were different among the three groups. The overall amputation rate increased with decreasing tcpO2 (p=0.014) although there was no significant difference for major amputations (p=0.448).


CONCLUSIONS
Routine assessment of tcpO2 is suitable as a clinical screening tool for estimating the risk of non-healing in diabetic foot ulcer patients without palpable pedal pulses. However, its predictive value for the risk of amputation remains unclear.
Department of General and Transplant Surgery, University Hospital of Tübingen, Germany. ruth.ladurner@med.uni-tuebingen.de
Ruth
R
Ladurner
Markus
M
Küper
Ingmar
I
Königsrainer
Stefan
S
Löb
Dörte
D
Wichmann
Alfred
A
Königsrainer
Stephan
S
Coerper
Stefan
S
Beckert
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D017719:Diabetic Foot / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D011237:Predictive Value of Tests; D012306:Risk; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing
D010100:Oxygen