title: The use of elevation and dependency to enhance the predictive value of transcutaneous oxygen pressure measurements in the assessment of foot amputation healing.
abstract: OBJECTIVE
  To determine whether transcutaneous oxygen pressure (TcPO₂) measurements taken while the patient is supine, with the limb elevated, and/or with the limb dependent (below the level of the heart) can be used to predict the healing of partial-foot amputations.
  
  
  METHODS
  Retrospective, observational study.
  
  
  METHODS
  A tertiary care, outpatient, multidisciplinary practice.
  
  
  METHODS
  A total of 373 patients who had supine, elevated, and dependent TcPO₂ measurements and underwent partial-foot amputation were identified by the use of a search of the Surgical Index database for procedure crossed with an electronic note retrieval database search.
  
  
  METHODS
  None.
  
  
  METHODS
  Amputation site healing.
  
  
  RESULTS
  For patients who underwent partial-foot amputation and healed in 3 months, the mean TcPO₂ value was 40.37 torr (SD 0.09); in the delayed-healing group, the mean TcPO₂ value was 28.36 torr (SD 1.16); in the nonhealed group, the mean TcPO₂ value was 22.79 torr (SD 1.14; P < .01 for each torr value). For the subgroup of patients with a TcPO₂ greater than 20 torr and less than 40 torr, in whom healing is more difficult to predict, the use of maneuvers of elevation and dependency increased both the positive and negative predictive values (56% and 74%, respectively) of the test compared with the use of supine measurements in isolation.
  
  
  CONCLUSIONS
  Supine TcPO₂ measurements can help predict amputation site healing in patients with ischemic wounds who require a partial-foot amputation. For the subgroup of patients with TcPO₂ values greater than 20 torr and less than 40 torr, adding TcPO₂ measurements with the limb elevated and/or dependent further improves the posttest probability and predictive values of the TcPO₂ measurements.
authors.affiliation: Department of Physical Medicine and Rehabilitation and Gonda Vascular Center, Mayo Clinic, Rochester, MN 55905, USA. andrews.karen@mayo.edu
authors.forename: Karen L
authors.initials: KL
authors.lastname: Andrews
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Boon
authors.forename: Mansour
authors.initials: M
authors.lastname: Dib
authors.forename: David A
authors.initials: DA
authors.lastname: Liedl
authors.forename: Alison
authors.initials: A
authors.lastname: Yacyshyn
authors.forename: Vincent
authors.initials: V
authors.lastname: Yacyshyn
mesh_terms: D000671:Amputation, Surgical; D001157:Arterial Occlusive Diseases / Q000601:surgery; D001785:Blood Gas Monitoring, Transcutaneous; D003925:Diabetic Angiopathies / Q000097:blood / Q000601:surgery; D005528:Foot / Q000098:blood supply*; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D012189:Retrospective Studies; D014945:Wound Healing / Q000502:physiology*