Preamputation evaluation of limb perfusion with laser Doppler imaging and transcutaneous gases

We studied 31 subjects with severe leg ischemia and 29 age-matched nonischemic control subjects to compare preamputation assessments of leg ischemia using laser Doppler imaging (LDI), transcutaneous partial pressure of oxygen (TcPO(2)), and transcutaneous partial pressure of carbon dioxide (TcPCO(2)...

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Vydané v:Journal of rehabilitation research and development Ročník 43; číslo 7; s. 891
Hlavní autori: Figoni, Stephen F., Scremin, Oscar U., Kunkel, Charles F., Opava-Rutter, Dorene, Johnson, Jessica, Schmitter, Eric D., Scremin, A.M. Erika
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: United States Department of Veterans Affairs 01.11.2006
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Predmet:
Amputation
Amputation - methods
Analysis of Variance
Blood Gas Monitoring, Transcutaneous
Carbon dioxide
Case-Control Studies
Doppler effect
Drug use
Gases
Heart failure
Humans
Ischemia
Ischemia - diagnosis
Ischemia - surgery
Laser-Doppler Flowmetry
Lasers
Legs
Linear Models
Male
Middle Aged
Moors and heaths
Physical examinations
Preoperative Care - methods
Reference Values
Sensitivity and Specificity
Skin - blood supply
Tibia - blood supply
Tibia - surgery
Tissues
Transmission Control Protocol/Internet Protocol (Computer network protocol)
Wound healing
ISSN:0748-7711, 1938-1352, 1938-1352
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Popis
Shrnutí:We studied 31 subjects with severe leg ischemia and 29 age-matched nonischemic control subjects to compare preamputation assessments of leg ischemia using laser Doppler imaging (LDI), transcutaneous partial pressure of oxygen (TcPO(2)), and transcutaneous partial pressure of carbon dioxide (TcPCO(2)). TcPO(2) and TcPCO(2) were evaluated with Novametrix Medical Systems, Inc, monitors (Wallingford, Connecticut) and perfusion (flux) of skin topically heated to 44 degrees C, and adjacent nonheated areas were evaluated with a Moor Laser Doppler Imager (Moor Instruments, Ltd; Devon, England). LDI flux of heated areas, its ratio to nonheated areas, and TcPO(2) (not TcPCO(2)) were lower in ischemic subjects than in control subjects. LDI flux ratio performed better than TcPO(2) in identifying ischemia, with fewer false positive and false negative results. Moreover, LDI flux of heated skin detected a proximal to a distal gradient of perfusion in ischemic subjects, while TcPO(2) did not. LDI was superior to TcPO(2) in discriminating correctly between ischemic and nonischemic skin. The results suggest that an LDI ratio below 5 indicates nonviable skin.
Bibliografia:ObjectType-Article-1
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ISSN:0748-7711
1938-1352
1938-1352
DOI:10.1682/JRRD.2006.`02.0014