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Tytuł:
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Toe Pressures are Superior to Duplex Parameters in Predicting Wound Healing following Toe and Foot Amputations.
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Autorzy:
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Stone PA; Division of Vascular and Endovascular Surgery, Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, WV. Electronic address: .
Glomski A; Center for Health Services and Outcome Research, Charleston Area Medical Center Health Education and Research Institute, Charleston, WV.
Thompson SN; Center for Health Services and Outcome Research, Charleston Area Medical Center Health Education and Research Institute, Charleston, WV.
Adams E; Division of Vascular and Endovascular Surgery, Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, WV.
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Źródło:
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Annals of vascular surgery [Ann Vasc Surg] 2018 Jan; Vol. 46, pp. 147-154. Date of Electronic Publication: 2017 Sep 06.
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Typ publikacji:
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Comparative Study; Journal Article
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Język:
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English
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Imprint Name(s):
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Publication: <2007->: Netherlands : Elsevier
Original Publication: Detroit : [Published by Expansion scientifique française for Annals of Vascular Surgery, Inc. and Association pour la promotion de la chirurgie vasculaire, Paris, c1986-
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MeSH Terms:
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Amputation, Surgical*/adverse effects
Ankle Brachial Index*
Blood Pressure*
Ultrasonography, Doppler, Duplex*
Wound Healing*
Foot/*blood supply
Foot/*surgery
Peripheral Vascular Diseases/*surgery
Toes/*blood supply
Toes/*surgery
Aged ; Chi-Square Distribution ; Clinical Decision-Making ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Peripheral Vascular Diseases/diagnostic imaging ; Peripheral Vascular Diseases/physiopathology ; Predictive Value of Tests ; Regional Blood Flow ; Reproducibility of Results ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome
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Entry Date(s):
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Date Created: 20170910 Date Completed: 20180725 Latest Revision: 20221207
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Update Code:
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20240105
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DOI:
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10.1016/j.avsg.2017.08.012
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PMID:
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28887264
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Background: No criteria, including preamputation vascular diagnostic thresholds, have been established to reliably predict healing versus nonhealing following minor lower extremity amputations. Thus, the goal of our study was to identify clinical factors, including noninvasive vascular laboratory measures, associated with wound healing following toe, forefoot, and midfoot amputations.
Methods: We retrospectively examined records of patients receiving elective toe, forefoot, or midfoot amputation at our institution over a 5-year span (2010-2015). A total of 333 amputations received noninvasive vascular assessment of the lower extremity preamputation and follow-up at 90 days postamputation. Multivariate binomial logistic regression was used to identify variables predicting wound healing as defined as the absence of reamputation due to wound breakdown.
Results: Wound healing occurred in 81% of amputations. A total of 23 (7%) patients required revisions of the foot while 39 (12%) patients required major amputations by 90 days. Chi-squared analysis found that toe pressure at or above the value of 47 mm Hg (P = 0.04), bi/triphasic anterior tibial (P = 0.01), and posterior tibial artery (P = 0.01) waveforms were associated with wound healing. When these diagnostic parameters were examined in the presence of confounders (increasing age, chronic kidney disease, and concomitant revascularization), only toe pressure ≥ 47 mm Hg predicted amputation site healing (odds ratio: 3.1 [95% CI: 1.0-9.4], P = 0.04).
Conclusion: Preamputation toe pressures of 47 mm Hg and above are associated with wound healing. No other noninvasive vascular studies predicted wound healing in the presence of confounders. Thus, toe pressures may assist in clinical decision-making and should be routinely obtained preamputation.
(Copyright © 2017 Elsevier Inc. All rights reserved.)
