A PROSPECTIVE EVALUATION OF TRANSCUTANEOUS OXYGEN MEASUREMENTS IN THEMANAGEMENT OF DIABETIC FOOT PROBLEMS

Purpose: To test the hypothesis that lower extremity transcutaneous ox ygen (TcPO2) measurements can accurately predict severity of foot isch emia and can be used to select appropriate treatment (conservative ver sus operative) for patients with diabetes and tissue necrosis or ische mic rest pain. Methods: Fifty-five patients with 66 limbs were prospec tively treated from Tune 1993 to July 1994. Noninvasive hemodynamic ar terial assessment and TcPO2 mapping of the involved limb were obtained before treatment was selected. If the transmetatarsal TcPO2 level was 30 mm Hg or greater, the patient's foot problem was managed conservat ively with local wound care, debridement, or a minor foot amputation. If the transmetatarsal TcPO2 level was less than 30 mm Hg, arteriograp hy was performed with the anticipated need for vascular reconstruction . The endpoints for determining treatment success or failure were comp lete wound healing or relief of ischemic rest pain. Results: Thirty-on e of 36 (86%) limbs with an initial transmetatarsal TcPO2 level of 30 mm Hg or greater were treated successfully with conservative care, inc luding 73% (11 of 15 feet) of limbs without a palpable pedal pulse. Af ter either bypass or angioplasty, 20 of 24 (83%) limbs achieved a tran smetatarsal TcPO2 level greater than. 30 mm Hg and had complete resolu tion of their presenting foot problem. An initial or postintervention transmetatarsal TcPO2 level of 30 mm Hg or greater was more accurate ( 90%, p = 0.001) than a palpable pedal pulse (65%, p = 0.009), in predi cting ultimate wound healing or resolution of rest pain. Conclusions: TcPO2 mapping is a useful noninvasive modality that can prospectively determine severity of foot ischemia, aid in selecting appropriate trea tment for patients with diabetes and foot salvage problems, and decrea se the total cost of such care.