An evaluation of the use of transcutaneous oxygen pressure measurement in the non-invasive vascular laboratory : with special reference to selection of amputation level (original) (raw)
Related papers
European Journal of Vascular and Endovascular Surgery, 1998
Objective: To determine the predictive power of laser Doppler fluxmetry (LDF), both heated and unheated, as a preoperative investigation of wound healing potential in dysvascular patients requiring amputation, by comparison with transcutaneous oxygen pressure measurement (Tcp09 and the limb to chest Tcp02 index. Methods: Thirty-five non-diabetic patients with peripheral vascular disease were investigated before amputation. Heated and unheated LDF and heated TcpOe measurements were taken on the chest wall and at the routine above-knee, belowknee and mid-foot amputation levels. Wound healing potential was evaluated against a Tcp02 index value of 0.55 and on clinical outcome. Results: A heated LDF value of 4.9 arbitrary units (au) was shown by receiver-operator characteristic curve to have the best predictive power, with an overall accuracy for preoperative prediction of wound healing of 91.4%, and a predictive value for wound failure of 89%. Based on the heated LDF of 4.9 au, review of 26 amputations performed shows the overall accuracy for preoperative prediction of wound healing of 92.3%, a predictive value for wound healing of 100%, and a predictive value for wound failure of 62.5%. Conclusion: A heated LDF value of 4.9 au appears to be a useful predictor of the potential of an amputation site to heal.
Noninvasive evaluation of peripheral vascular disease using transcutaneous oxygen tension
The American Journal of Surgery, 1982
Excessive morbidity and mortality are associated with wound breakdown in ischemic tissues after vascular reconstruction and amputation [I]. Doppler pressure measurements [2], pulse volume recording [3], thermography [4], skin perfusion [5], and xenon-131 clearance [6] have been used to assess wound healing potential and quantitate skin blood flow. Arteriography remains the standard for determining the distribution of vascular lesions, but it does not quantitate local tissue perfusion. This report describes the use of a transcutaneous partial pressure of oxygen (PtcOs) monitoring electrode (Tcomette,
2019
Objective: Surgeons often recur to Transcutaneous Oxygen Pressure (TCOP) measurements to select the amputation level in patients with critical limb ischemia. Thirty-five mmHg are considered as acceptable threshold for uneventful stump healing. Methods: Single-centre cohort over 11 years. Results: We included 303 amputations in 211 adult patients. Forty-two amputations (14%) concerned the mid-foot, 7 (2%) the ankle, 154 (51%) the leg, 28 (9%) the knee joint and 72 (24%) the thigh region. We witnessed 78 stump failures (78/303; 26%) defined as the need for surgical revision or new-level amputation. Our TCOP threshold of 35 mmHg did not discriminate between success and stump failure. Specifically, considering foot and ankle amputations, a 20 mmHg value yielded the same prediction for stump failure as 40 mmHg. The sensitivity, specificity, positive and negative predictive values of a threshold of 35 mmHg for stump failure in foot amputations were 58%, 48%, 56%, and 50%, respectively. Th...
Journal of Vascular Surgery, 1988
Various tests are used preoperatively to differentiate patients who require an above-knee amputation (AKA) from those whose vascular supply is adequate to heal a below-knee procedure (BKA). This 15-month study of 109 amputations compared four of these methods: segmental Doppler systolic pressure measurements, transcutaneous oxygen measurement (tcPo2), fluorescein angiography, and skin thermometry. There were 66 BKAs (85% healed primarily) and 43 AKAs (93% healed primarily). The actual level of amputation was determined by the operating surgeon without consideration of the preoperative test results, and the incidence of healing was then related to the test parameters. The average skin temperature at the amputation site was higher (93.7 ° F) in the group that healed primarily compared with those who required operative stump revision (89.9 ° F) (p < 0.001). The mean midcalf tcPo2 was also higher in the BKA group that healed (Po2-36.6 mm Hg) compared with those who failed (Po2-16.4 mm Hg) (p < 0.001). Qualitative skin fluorescence was less successful in differentiating success from failure. Of the 63 BKAs that fluorescein predicted would heal, eight failed (13%). Doppler pressures at the thigh, popliteal, midcalf, or ankle level were unreliable in predicting healing of a BKA. Formulation of indexes relating absolute pressures to the brachial systolic pressure did not improve the value of this examination. From this review it is concluded that the skin temperature and tcP02 obtained at the site of proposed amputation were the most reliable prognostic noninvasive examinations. Depending on which test was used, routine application of the noninvasive predictors in this study as the sole determinant of amputation level would have resulted in an AKA in 17% to 60% of patients whose amputations otherwise would have healed at a lower level. Objective data can supplement clinical judgment but not replace it.
The American surgeon, 2001
Hyperbaric oxygen (HBO) therapy may be a useful adjunct in the treatment of patients with wounds associated with critical limb ischemia. These patients either cannot undergo a successful bypass or may not heal after vascular reconstruction alone. Identification of patients likely to benefit from HBO is essential before treatment, as this therapy is time-consuming, costly, and not without risk. Transcutaneous oxygen measurements (TCOM) can be used to evaluate the degree of hypoxia in ischemic tissue. In this study we evaluated whether TCOM could be used to identify those patients who would or would not benefit from HBO therapy. Our hypothesis is that a difference in transcutaneous oxygen tension readings measured near the ischemic lesion with the patient breathing room air and while breathing 100 per cent oxygen at ambient pressure may be predictive of wound healing with adjunctive hyperbaric oxygen therapy. Thirty-six patients with critical limb ischemia and nonhealing ulcers were r...
Influence of negative-pressure wound therapy on tissue oxygenation of the foot
Archives of plastic surgery, 2014
Negative-pressure wound therapy (NPWT) is believed to accelerate wound healing by altering wound microvascular blood flow. Although many studies using laser Doppler have found that NPWT increases perfusion, recent work using other modalities has demonstrated that perfusion is reduced. The purpose of this study was to investigate the influence of NPWT on tissue oxygenation of the foot, which is the most sensitive region of the body to ischemia. Transcutaneous partial pressure of oxygen (TcpO2) was used to determine perfusion beneath NPWT dressings of 10 healthy feet. The sensor was placed on the tarso-metatarsal area of the foot and the NPWT dressing was placed above the sensor. TcpO2 was measured until it reached a steady plateau state. The readings obtained at the suction-on period were compared with the initial baseline (pre-suction) readings. TcpO2 decreased significantly immediately after applying NPWT, but gradually increased over time until reaching a steady plateau state. The...
Annals of Vascular Diseases
Objective: To determine the prognostic value of regional tissue oxygenation saturation (rSO 2) for ulcer healing after endovascular treatment (EVT) of peripheral arterial disease (PAD). Materials and Methods: Among PAD patients, 34 patients with chronic limb-threatening ischemia underwent EVT for limb salvage. We retrospectively analyzed the cutoff rSO 2 values on postoperative day 1 to predict ulcer healing and patient prognosis. Skin perfusion pressure (SPP) and transcutaneous oxygen pressure (TcPO 2) were also used to assess wound healing. Results: A finger-mounted tissue oximeter can easily measure rSO 2 on the dorsal foot. Among the 34 patients, the ulcer healed in 25, and no changes were observed in 2 patients at 1 month after EVT. However, 7 patients needed major amputation at the same time. Wound healing was achieved in all patients with rSO 2 ≥50%. With this cutoff, the sensitivity and specificity of the new device for wound healing were 100% and 64%, respectively. In all the wound healing cases, SPP was ≥45 mmHg, and TcPO 2 was ≥40 mmHg. Conclusion: To assess limb ischemia, rSO 2 can be measured quickly and easily using this device. We suggest that an rSO 2 >50% shows good prognosis for ulcer healing.