title: Prediction of wound healing after minor amputations of the diabetic foot.
abstract: OBJECTIVE
  To identify any significant differences in physiological test results between healing and non healing amputation sites.
  
  
  METHODS
  A single center prospective non-experimental study design was conducted on fifty subjects living with type 2 diabetes and requiring a forefoot or toe amputation. Subjects underwent non-invasive physiological testing preoperatively. These included assessment of pedal pulses, preoperative arterial spectral waveforms at the ankle, absolute toe pressures, toe-brachial pressure index and ankle-brachial pressure index. After 6 weeks, patients were examined to assess whether the amputation site was completely healed, was healing, had developed complications, or did not heal.
  
  
  RESULTS
  There was no significant difference in ABPI between the healed/healing and the non-healing groups. Mean TBI (p=0.031) and toe pressure readings (p=0.014) were significantly higher in the healed/healing group compared to the non healing group. A significant difference was also found in ankle spectral waveforms between the two groups (p=0.028).
  
  
  CONCLUSIONS
  TBIs, toe pressures and spectral waveforms at the ankle are better predictors of likelihood of healing and non-healing after minor amputation than ABPIs. ABPI alone is a poor indicator of the likelihood of healing of minor amputations and should not be relied on to determine need for revascularization procedures before minor amputation.
authors.affiliation: Department of Health, Malta.
authors.forename: Luana
authors.initials: L
authors.lastname: Caruana
authors.affiliation: Faculty of Health Sciences, University of Malta. Electronic address: Cynthia.formosa@um.edu.mt.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Formosa
authors.affiliation: Department of Health, Malta; Faculty of Medicine and Surgery, University of Malta.
authors.forename: Kevin
authors.initials: K
authors.lastname: Cassar
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000009:adverse effects*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D017719:Diabetic Foot / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D003935:Diagnostic Techniques, Cardiovascular; D005260:Female; D005545:Forefoot, Human / Q000098:blood supply* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000209:etiology; D011237:Predictive Value of Tests; D011379:Prognosis; D014034:Toes / Q000098:blood supply* / Q000503:physiopathology / Q000601:surgery; D014945:Wound Healing / Q000502:physiology*
keywords: Ankle blood pressure; Atherosclerosis; Diabetes; Minor forefoot amputations; Toe blood pressure; Wound healing