DISTAL BLOOD-PRESSURE AS A PREDICTOR FOR THE LEVEL OF AMPUTATION IN DIABETIC-PATIENTS WITH FOOT ULCER

The predictive value of distal blood pressure measurements for the lev el of amputation was studied prospectively in 161 consecutive diabetic patients with foot ulcers. The patients were treated as outpatients e xcept for periods of surgery and when complications requiring hospital care occurred. All patients were treated pre- and postoperatively by the same multidisciplinary foot care team. Either ankle or toe blood p ressure measurement was available in 86% of the patients. Incompressib le arteries, ulcer or gangrene at the measuring site, previous amputat ion, poor general condition, and an emergency situation were factors t hat excluded standardized ankle and toe blood pressure measurements in 24% and 27% of the patients, respectively. An absolute lower ankle pr essure level of 50 mm Hg was found, below which a minor amputation was never sufficient to achieve healing. An ankle pressure below 75 mm Hg was seldom sufficient, and at or above that pressure level, the ankle pressure had no predictive value in this respect. At a toe pressure b elow 15 mm Hg, a minor amputation was seldom sufficient. Ankle and toe pressure indices gave no further information.