PREDICTION OF AMPUTATION WOUND-HEALING WITH SKIN PERFUSION-PRESSURE

Purpose: The purpose of this study was to determine whether laser Dopp ler skin perfusion pressure (LD-SPP) could accurately predict amputati on wound healing. Methods: We studied a total of 62 limbs in 52 patien ts (28 men and 24 women) with a mean age of 62.2 years (range 34 to 93 years). From this, 39 limbs underwent major amputation (15 above-the- knee, 24 below-the-knee), and 23 limbs underwent minor amputations (4 transmetatarsal and 19 toes). There were five postoperative deaths, le aving a total of 57 limbs available for analysis. Results: Three of 13 above-knee amputations failed to heal. Twenty-one of 23 below-knee am putations healed. Three of four transmetatarsal amputations failed to heal and eight of 17 toe amputations failed to heal. Binary table anal ysis showed that an LD-SPP value of 30 mm Hg or greater had a negative predictive value (healing occurred) of 90%. An LD-SPP value of less t han 30 mm Hg at the amputation site had a positive predictive value (h ealing failure) of 75%, (p < 0.001, chi square analysis). For major am putations, negative predictive value was 100%, and positive predictive value was 83% (p < 0.001). For minor amputations, negative predictive value was 75% and positive predictive value was 66.7%, (p < 0.09). Co nclusion: These data support the use of the LD-SPP test in the selecti on of major amputation level consistent with healing in ischemic limbs . Further study of the value of this parameter in the determination of minor amputation wound healing is necessary.